Liver lobe torsion

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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.[1] 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.[2] In most cases it is the pendulous caudal process of the caudal lobe, which sits over the right kidney, that twists.[3]

Symptoms

  • Anorexia
  • Lethargy
  • Jaundice
  • Anemia
  • Abdominal pain

Causes

The cause of liver lobe torsion in rabbits is unknown, but predisposing factors are thought to include the following:[4]

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

Lop-eared rabbits are over-represented in case loads for unknown reasons.

Diagnosis

Biochemical abnormalities include the following:[2]

  • 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.[5] 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.[2]

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 prokinetic 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.[4]

Experiences

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

The following are a few scientific case studies.

Chilli's story

Chill in recovery. NOTE: Clicking on the image will show the full resolution graphic image.

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. ❤️

Further reading

See also

References

  1. ↑ K. Stamatova-Yovcheva et al. (2012). Anatomical Macromorphological Features of the Domestic Rabbits (Oryctolagus Cuniculus)
  2. ↑ 2.0 2.1 2.2 Varga, M. (2013). Textbook of rabbit medicine. (2nd ed.).
  3. ↑ Harcourt-Brown, F. (n.d.). Liver lobe torsion. Retrieved 12 March 2016 from https://www.harcourt-brown.co.uk/articles/sudden-or-unexpected-death/differential-diagnosis-list/liver-lobe-torsion
  4. ↑ 4.0 4.1 J.E. Graham et al. (2014). Liver Lobe Torsion in Pet Rabbits: Clinical Consequences, Diagnosis, and Treatment. Retrieved 14 Mar 2017 from https://www.researchgate.net/publication/261917236_Liver_Lobe_Torsion_in_Pet_Rabbits_Clinical_Consequences_Diagnosis_and_Treatment
  5. ↑ vetstream. (n.d.). Liver: lobe torsion. Retrieved 25 Nov 2020 from https://www.vetstream.com/treat/lapis/freeform/liver-lobe-torsion
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