ISSN 2398-2969      

Liver: lobe torsion

Clapis

Synonym(s): Hepatic lobe torsion


Introduction

  • Cause: the cause of liver lobe torsion is unknown. However, predisposing factors such as laxity of supporting hepatic ligaments, trauma, dilation of other abdominal organs and variations in hepatic shape secondary to neoplasia, infection and parasitic infestation are suspected.
  • Signs:  the clinical signs are non-specific (anorexia, lethargy, gut stasis, abdominal pain) and can vary from non-clinical signs to sudden death. At physical examination, the rabbit may present with lethargy, reduced gut sounds, abdominal pain and palpable gastrointestinal gas. 
  • Diagnosis: hematology and biochemistry can lead to a presumptive diagnosis of liver lobe torsion. Blood results generally show mild to moderate anemia and moderate to marked increased liver enzymes.  Radiography and ultrasonography can be unremarkable at early presentation. In many cases the torsed lobe may be palpated as a hard, painful mass, usually in the right cranial quadrant of the abdomen. At later stages of the condition, radiography and ultrasonography may show hepatomegaly, increased gas within the gastrointestinal tract and free peritoneal fluids. Color flow Doppler shows a lack of or decreased blood flow in the affected lobe. 
  • Treatment: prompt supportive treatment is paramount for a favorable outcome.  Surgical treatment involves laparotomy and lobectomy once the patient has been stabilized.
  • Prognosis: surgical treatment seems to lead to a more favorable prognosis than medical treatment alone. 
  • From 1975-2014, over 30 cases of hepatic lobe torsion have been reported; a case of partial liver torsion was also reported in 1987. It is believed that the condition is not uncommon as many cases would not be reported. Anecdotally it would appear that some rabbits make a spontaneous recovery from this condition.

Presenting signs

  • The presenting signs are generally non-specific for this condition.
  • Anorexia.
  • Lethargy.
  • Reduced fecal output.
  • Soft fecal pellets.
  • Dysuria.
  • Gut stasis.
  • Hunched body position.
  • Hiding behavior.
  • Sudden death.

Acute presentation

  • Clinical signs generally develop within 1 day.

Age predisposition

  • Age ranges of 18-24 months have been reported, with a median age of 5.15 years.
  • The single reported cases presented an age range of 1-6 years.

Breed predisposition

Cost considerations

  • Liver lobe torsion in rabbits presents a more favorable prognosis if treated surgically. However, successful medical treatment has also been reported.
Medical approach
  • Two days of hospitalization (1-3 days or as long as deemed necessary).
  • Hematology and biochemistry blood test.
  • Radiographic and ultrasonographic examination.
  • Supportive treatment: analgesia, fluid therapy, antibiotics, prokinetics and assist feeding.
Surgical approach 
  • May require 4 days of hospitalization (3-6 days). Many cases may be discharged on the day of surgery if diagnosed early and operated on promptly and showing a prompt and adequate recovery.
  • Hematology and biochemistry blood test.
  • Radiographic and ultrasonographic examination. 
  • Anesthesia and surgery (laparotomy and lobectomy). 
  • Supportive treatment: analgesia, fluid therapy, antibiotics, prokinetics and assist feeding.

Special risks, eg anesthetic

  • Shock. 
  • Anesthesia. 
  • Sudden worsening of the patient.

Pathogenesis

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Diagnosis

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Treatment

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Sequelae

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Graham J & Basseches J (2014) Liver lobe torsion in pet rabbits: clinical consequences, diagnosis, and treatment. Vet Clin North Am Exot Anim Pract 17 (2), 195-202 PubMed
  • DeCubellis J & Graham J (2013) Gastrointestinal disease in guinea pigs and rabbits. Vet Clin North Am Exot Anim Pract 16 (2), 421-435 PubMed.
  • Stanke N J, Graham J E, Orcutt C J et al (2011) Successful outcome of hepatectomy as treatment for liver lobe torsion in four domestic rabbits. JAVMA 238 (9), 1176-1183 PubMed
  • Saunders R, Redrobe S, Barr F et al (2009) Liver lobe torsion in rabbits. J Small Anim Pract 50 (10), 562 PubMed
  • Wenger S, Barrett E L, Pearson G R et al (2009) Liver lobe torsion in three adult rabbits. J Small Anim Pract 50 (6), 301-305 PubMed
  • Taylor H R & Staff C D (2007) Clinical techniques: successful management of liver lobe torsion in a domestic rabbit (Oryctulagus cuniculus) by surgical lobectomy. J Exot Pet Med 16 (3), 175-178 ResearchGate
  • Wilson R B, Holscher M A & Sly D L (1987) Liver lobe torsion in a rabbit. Lab Anim Sci 37 (4), 506-507 PubMed
  • No Authors (1983) [Partial liver torsion in a rabbit.] Dtsch Tierarztl Wochenschr 90 (12), 533-534 PubMed.
  • Weisbroth S H (1975) Torsion of the caudate lobe of the liver in the domestic rabbit ( Oryctolagus). Vet Pathol 12 (1), 13-15 PubMed.

Other sources of information

  • Varga M (2014) Digestive Disorders. In: Textbook of Rabbit Medicine. 2nd edn. Butterworth Heinemann.
  • Grint N (2013) Anaesthesia. In: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. Eds: Harcourt-Brown F & Chitty J. BSAVA. pp 1-25.
  • Lennox A M (2013) Radiographic Interpretation of the Abdomen. In: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. Eds: Harcourt-Brown F & Chitty J. BSAVA, UK. pp 90.
  • Redrobe S (2013) Ultrasonography. In: BSAVA manual of Rabbit Surgery, Dentistry and Imaging. Eds: Harcourt-Brown F & Chitty J. BSAVA, UK. pp 102.
  • Saunders R (2013) Exploratory Laparotomy. In: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. Eds: Harcourt-Brown F & Chitty J. BSAVA, UK. pp 169-171.
  • Oglesbee B & Jenkins J (2012) Gastrointestinal Diseases. In: Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery. Eds: Quesenberry K & Carpenter J. pp 202-203

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