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.

The Rabbit Doctors
The Rabbit Doctors (November 22, 2022) posted on facebook:

"Liver lobe torsion is a life threatening condition that can affect adult rabbits of any age. The liver is made up of several lobes, and usually the caudate lobe (the smallest one) can spontaneously twist, cutting off its blood supply. The blood vessels in this area can also tear or rupture as it twists, leading to severe blood loss. It is a very painful condition, and usually requires surgery to remove the damaged lobe. Occasionally the lobe untwists itself and the bunny can recover without surgery. We are currently seeing about 3 cases a month, and taking most of these to surgery, successfully. Diagnosis is by blood tests, and then an ultrasound scan of the abdomen. We don’t know why this happens in rabbits – it seems lop rabbits are more at risk, so we are currently undertaking a study to find out more about this poorly understood condition."

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


 * Bunny Binkies Club. (2022). Faith's story
 * Central Hospital for Veterinary Medicine. (2022). Doug's story
 * Little Critters Veterinary Hospital. (2022). Cashew's story
 * The Unusual Pet Vets. (2022). Dr Squid's story
 * The Unusual Pet Vets. (2022). Jerry's story
 * The Unusual Pet Vets. (2022). Arthur's story
 * Kelly Montana. (2022). Dusty Hopman's story
 * Holly Boyden. (2021). Rabbit liver lobe torsion
 * Exotic Vet Care. (2021). A Twisted Tale: Liver Lobe Torsion in Rabbits – Mme. Matilda Munyon, Rabbit Blogger
 * Bunny Binkies Club. (2020). Post about Amos
 * Highcroft Rabbit, Small Mammal & Exotic Vets. (2018). Facebook post about Hugo
 * mimimomo. (2018). Liver lobe torsion
 * Booplesnoot. (2016). Boople has Liver Lobe Torsion - surgery today
 * Lili. (2015). Liver-node torsion
 * Lagomorphic. (2015). Liver torsion.
 * Meadow_Angel. (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)

Chilli's story
Posted by Harris Hill and Gibbons vets on December 20, 2021:

This is a story about how important it is to bring your small furry friends to the vets as soon as you see they aren’t themselves. 🐰 📖 Chilli the Netherland Dwarf (black rabbit) came to see our vet Jade after his owner noticed that he just wasn’t quite right. He wasn’t as active as he usually is and he wasn’t eating as quickly as normal. Chilli’s companion Doc (grey rabbit) also seemed a bit subdued so accompanied his friend just in case.

Jade gave Doc a clean bill of health and guessed that he was likely upset and stressed by his friend being poorly, but she was very worried about Chilli. Chilli was quiet and had very pale gums and mucous membranes. Chilli was admitted to the Trowbridge practice for an ultrasound and a blood test to check his red blood cell levels. Jade found that Chilli was severely anaemic and the ultrasound showed that he had a liver lobe torsion. This is a condition where part of the liver twists on its self-causing the blood supply to be cut off.

Chilli was now bleeding internally from his liver. Chilli was given intravenous fluids, strong pain killers and warmed up to stabilise him before emergency surgery that afternoon. Vet Nurse Rosie had the important task of monitoring Chilli’s anaesthetic, while Jade with the help of vet nurse Alex, operated to remove the diseased part of Chilli’s liver.

Chilli pulled through the surgery, but the morning after he was still quite weak and the vets were worried he might need a blood transfusion, so vet Jade’s bunny gang (Pumpkin, Pringle and Sylvie) came to work with her that day to be on standby in case they needed to be donors. Luckily they weren’t needed and Chilli quickly perked up. He spent a couple of days with us to make sure he was strong enough before going home with his friend Doc, who had stayed with him for support the whole time. We are happy to report that Chilli is doing really well at home and is getting back to being his normal mischievous self. Chilli’s owners got him to the vets without delay after noticing subtle changes in their rabbits’ behaviour. Often the first sign (and one of the only signs) of a rabbit or guinea-pig being unwell is that they go off their food. This should always be taken seriously and an urgent veterinary assessment is needed. They could have a life threatening illness that could progress rapidly, as in Chilli’s case. ❤️