Liver lobe torsion

The rabbit liver is composed of five lobes -- the right hepatic lobe, caudate and quadrate lobes are single, and the left hepatic one is separated in lateral and medial parts. Liver lobe torsion, also known as hepatic lobe torsion or hepatic infarction, occurs when a lobe of the liver twists about an axis perpendicular to the organ's base of support which causes venous congestion and eventually diffuse necrosis of the lobe. In most cases it is the pendulous caudal process of the caudal lobe, which sits over the right kidney, that twists.

Symptoms

 * Anorexia.
 * Lethargy.
 * Jaundice.
 * Abdominal pain.

Causes
The cause of liver lobe torsion in rabbits is unknown, but predisposing factors are thought to include the following:


 * Surgical or external trauma
 * Congenital absence of hepatic ligaments
 * Dilation of abdominal organs
 * Parasitic and bacterial infection
 * Neoplasia

Diagnosis
Biochemical abnormalities include the following:
 * anaemia
 * increased alanine aminotransferase (ALT)
 * increased aspartate aminotransferase (AST)
 * increased gamma-glutamyl transferase (GGT)

Definitive diagnosis is by radiography or ultrasonography, although they can be unremarkable at early presentation. The twisted lobe can often be palpated as a hard painful mass in the back right cranial quadrant of the abdomen.

Treatment
Treatment is surgical by removing the affected liver lobe. Rabbits with liver lobe torsion will require very good supportive care during the surgery.

Rabbits may also be treated with supportive care only. In a case study by Graham and colleagues, seven out of 16 rabbits were treated with supportive care only, and of these, three rabbits (43%) survived. Supportive care included subcutaneous fluids, pain medication, antimicrobials, supplemental feeding, and prokenetic agents. Surviving rabbits had normal or improved clinicopathologic tests one week to 2 months after the original presentation and had multiple episodes of recurrent GI stasis within the first 1 to 2 months following hospitalization.

Experiences
The following articles are anecdotal experiences of owners with rabbits that had liver lobe torsion.


 * Highcroft Rabbit, Small Mammal & Exotic Vets. (2018). Facebook post about Hugo (Graphic)
 * BinkyBunny.com. (2016). Boople has Liver Lobe Torsion - surgery today
 * BinkyBunny.com (2015). Liver-node torsion
 * BinkyBunny.com. (2015). Liver torsion.
 * Bunspace. (2010). Liver Torsion

The following are a few scientific case studies.


 * Graham, JE et al. (2014). Liver Lobe Torsion in Rabbits: 16 Cases (2007 to 2012)
 * Samour, J. (2012). Exotic Animal Medicine - review and test, Case 1.4, Lennox A.
 * Stanke N et al. (2011). Successful outcome of hepatectomy as treatment for liver lobe torsion in four domestic rabbits
 * Wenger, S et al. (2009). Liver lobe torsion in three adult rabbits
 * Weisbroth, SH. (1975). Torsion of the Caudate Lobe of the Liver in the Domestic Rabbit (Oryctolagus)