Successful outcome of hepatectomy as treatment for liver lobe torsion in four domestic rabbits

Abstract

Case Description—4 rabbits (1.5 to 6 years old) were evaluated at the Angell Animal Medical Center from June 2007 to March 2009 because of nonspecific clinical signs including anorexia, lethargy, and decreased fecal output. Clinical Findings—Physical examination revealed signs of pain in the cranial portion of the abdomen, gas distention of the gastrointestinal tract, and diminished borborygmi. Serum biochemical analyses and CBCs revealed moderately to markedly high alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase activities and mild to moderate anemia with polychromasia. Abdominal radiographic findings were nonspecific. Three of the 4 rabbits underwent abdominal ultrasonography; abnormalities in shape, size, echogenicity, and blood flow of the liver, indicative of liver lobe torsion, were detected. Treatment and Outcome—All 4 rabbits underwent surgery, during which liver lobe torsion was confirmed and the affected liver lobe was resected. Histologic examination of sections of the excised lobe obtained from 3 of the 4 rabbits revealed severe, diffuse, acute to sub-acute hepatic ischemic necrosis. All rabbits recovered from surgery; owners reported that the rabbits were doing well 22 to 43 months after surgery. Clinical Relevance—Liver lobe torsions in any species are rarely reported, yet 4 cases of liver lobe torsion in domestic rabbits were treated at 1 referral center in a 2-year period. In rabbits, clinical signs of this condition are nonspecific and results of additional tests, including abdominal ultrasonography and serum biochemical analysis, are necessary for diagnosis. Prompt diagnosis and hepatectomy of the affected lobe are recommended and appear to be associated with an excellent prognosis.

Gastrointestinal Disease in Guinea Pigs and Rabbits

“…[64][65][66] Rabbits with this condition present with nonspecific signs of GI stasis and some have cranial abdominal pain or an abnormally placed liver lobe on abdominal palpation. Because signs can be nonspecific, it is advisable to perform blood work on all rabbits presenting with nonspecific signs of GI stasis.…”

“…the patient is stable for surgery. 65 If an owner declines surgery, supportive care measures alone (fluids, syringe feeding, prokinetic agents, analgesics, and antibiotics, if indicated) are still indicated. The author (JG) has documented survival in 3 of 6 rabbits with liver lobe torsion treated with supportive care measures alone.…”

Gastrointestinal Disease in Exotic Small Mammals

“…10). [56][57][58] Rabbits that are young to middle-aged (1.5 to 6 years old) appear to be most likely affected by this disease, which is associated with nonspecific clinical signs and decreased fecal output. Elevated hepatic enzymes are often observed but have not proven to be repeatable across rabbit liver lobe torsion cases.…”

“…Ultrasonographic findings may reveal abdominal effusion, lack of blood flow in the affected lobe, and heterogenous parenchyma with anechoic to hypoechoic striations. 56,57 The liver lobe most frequently affected in rabbit is the caudate lobe, but other lobes are susceptible. 56,57 The underlying etiology for liver lobe torsion in rabbits includes adjacent organ distension and the narrow attachment of the caudate lobe.…”

Liver disease in rabbits

“…Hyperlactataemia may also be detected. Abdominal ultrasonography and rapid surgical intervention are indicated in these cases, and prompt hepatectomy and supportive care carries a good prognosis (Stanke and others 2011). …”