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Liver Lobe Torsion in Rabbits: 16 Cases (2007 to 2012)

Graham, Jennifer E., Orcutt, Connie J., Casale, Sue A., Ewing, Patty J., Basseches, Jessica
Journal of exotic pet medicine 2014 v.23 no.3 pp. 258-265
alanine transaminase, alkaline phosphatase, anemia, anorexia, aspartate transaminase, blood serum, breeds, creatinine, delimbing, enzyme activity, histopathology, image analysis, laparotomy, liver, necropsy, prognosis, rabbits, ultrasonics, ultrasonography, urea nitrogen, Massachusetts
The objective of this retrospective case series was to determine the clinical signs, diagnostic test results, treatment protocols, and outcomes of rabbits treated for liver lobe torsion during a 5-year period at a large referral institution. A total of 16 rabbits diagnosed with liver lobe torsion at Angell Animal Medical Center (Boston, MA USA) during January 2007 to March 2012 were included in the study. The diagnosis of liver lobe torsion was made at surgery, during abdominal ultrasound, or on postmortem examination. Medical records of the subject animals were reviewed for signalment, history, clinical signs, results of clinical pathology testing, diagnostic imaging findings, treatment, surgical and histopathology findings, hospitalization time, and outcome. The most common clinical signs of rabbits diagnosed with liver lobe torsion in this study included anorexia, lethargy, and decreased fecal production lasting 1 day. Lop breeds, particularly mini lops, were overrepresented. Anemia was the most common hematologic abnormality, while elevated levels of alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, and creatinine were the most common serum biochemical abnormalities. Abdominal ultrasonography with Doppler assessment was used in 14 rabbits and provided a diagnosis of liver lobe torsion in all cases. The caudate lobe was involved in 10 rabbits (62.5%, 95% CI: 38.8 to 86.2), followed by the right lateral lobe (n = 5; 31.25%, 95% CI: 8.6 to 53.9), the left lateral lobe (n = 2; 12.5%, 95% CI: 3.7 to 28.7), and the right medial lobe (n = 1; 6.25%, 95% CI: 5.6 to 18.1). Two rabbits had more than 1 torsed liver lobe. Exploratory laparotomy and liver lobectomy were performed in 9 rabbits, and all of them survived. Supportive care alone was provided for 7 rabbits, 3 of which survived. The results suggest that nonspecific clinical signs of anorexia, lethargy, and decreased fecal production, in conjunction with anemia and high serum hepatic enzyme activities, should increase the index of suspicion for liver lobe torsion in rabbits. Abdominal ultrasonography with Doppler assessment is useful to confirm the diagnosis. The long-term prognosis for rabbits undergoing liver lobectomy and surviving the hospitalization period is excellent.