Gallbladder and Liver Lobe Torsion in a Young Cat Presented with Hemoabdomen

Abstract

An 11 mo old domestic shorthair presented with acute lethargy. The cat was hypothermic and bradycardic and had pale pink mucous membranes, poor pulses, and a distended abdomen. Point-of-care ultrasound identified significant abdominal effusion, which was diagnosed to be a hemoabdomen. Bloodwork revealed hyperlactatemia, regenerative anemia, neutrophilia, hypoproteinemia, hypoalbuminemia, and increased alanine aminotransferase. The cat received an allotransfusion and a subsequent canine xenotransfusion and received further supportive therapy. After stabilization, abdominal ultrasonography diagnosed a gallbladder and liver lobe torsion with hemoabdomen. Exploratory laparotomy confirmed the torsion of the right medial and quadrate hepatic lobes together with the gallbladder. Cholecystectomy and lobectomy of the affected lobes were performed using a surgical stapler. The cat was discharged after 4 days. Histopathology confirmed hemorrhagic infarction of the liver lobes and gallbladder, consistent with the described torsion, and the hepatic pseudocyst. It also demonstrated a mucocele in the gallbladder. One month postoperatively, the cat had totally recovered. Hepatic lobe torsion without neoplasia is a rare disease in cats, with variable clinical signs. Gallbladder torsion is a hitherto unreported condition in cats. This is the first report of gallbladder and liver lobe torsion with secondary hemoabdomen in a cat, successfully treated by one-stage surgery.

Acute liver lobe torsion in a kitten

“…[1][2][3]5,6 A report of an 11-month-old kitten diagnosed with torsion of the right medial and quadrate liver lobes along with the gallbladder was presented at the ECVS Annual Scientific Meeting in 2019. 4 A pseudocyst and hemorrhagic infarction associated with a mucocele was discovered on histopathologic examination of the liver segments and gallbladder in this kitten. 4 In the present case, the cause for LLT is unknown.…”

“…4 A pseudocyst and hemorrhagic infarction associated with a mucocele was discovered on histopathologic examination of the liver segments and gallbladder in this kitten. 4 In the present case, the cause for LLT is unknown. There was no history of trauma, neoplasia, diaphragmatic hernia or congenital abnormalities predisposing to LLT.…”

“…To our knowledge, there are six published feline case reports of LLT (11-month-old, 5-, 6-, 10-, 13-and 15.7year-old cats). [1][2][3][4][5][6] This is the first peer-reviewed report of LLT in a kitten. In the six previous reports, five were diagnosed at the time of surgery, while the remaining cat was diagnosed post mortem.…”

“…Previous cases in dogs and cats have reported abdominal pain, lethargy, vomiting, anorexia, collapse and diarrhea, all of which are non-specific for LLT. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The most significant physical examination finding in this case suggestive of LLT was a palpable abdominal mass effect and abdominal pain. In previous cases in dogs and cats, abdominal pain, abdominal distension and a palpable abdominal mass were reported.…”

“…In previous cases in dogs and cats, abdominal pain, abdominal distension and a palpable abdominal mass were reported. [1][2][3][4]6,7,9,10,[12][13][14][15][16][17][18] This kitten exhibited signs of hypovolemic shock and severe decompensation on presentation. It is suggested that the severity of presentation depends on the degree of torsion and occlusion of hepatic blood flow, leading to hepatic congestion, arterial and venous thrombosis, and subsequent necrosis.…”