Liver lobe torsion in dogs: 13 cases (1995-2004)

OBJECTIVE: To determine history, results of diagnostic testing, surgical findings, complications, and outcome for dogs with liver lobe torsion (LLT). DESIGN: Retrospective case series. ANIMALS: 12 dogs (1 with 2 episodes). PROCEDURE: Signalment, clinical signs, clinicopathologic findings, radiographic and ultrasonographic findings, surgical and histologic findings, complications, and hospitalization time were evaluated. RESULTS: The most common clinical signs were nonspecific abnormalities (eg, vomiting, lethargy, and anorexia) of acute or chronic duration. All dogs were large-breed dogs (median body weight, 37.2 kg [82 lb]). Biochemical abnormalities included high alanine amino-transferase (n = 12) and aspartate aminotransferase (11) activities. Results of abdominal ultrasonography were supportive of the diagnosis in 5 of 8 cases. Affected lobes included the left medial lobe (n = 4), left lateral lobe (3), papillary process of the caudate lobe (2), caudate lobe (1), and right lateral lobe (1). Exploratory celiotomy and liver lobectomy were performed in 12 of 13 cases, and in 11 of those 12 cases, the dog survived. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that development of nonspecific clinical signs of vomiting, lethargy, and anorexia in conjunction with high serum hepatic enzyme activities and mature neutrophilia in a medium-sized or large-breed dog should increase the index of suspicion for LLT. Abdominal ultrasonography with Doppler assessment may be useful in establishing the diagnosis. The long-term outcome for dogs that survive the hospitalization period is excellent.     

Liver lobe torsion in three adult rabbits

This paper describes three cases of liver lobe torsion in rabbits presenting with anorexia, lethargy, jaundice and abdominal pain. This condition was associated with anaemia and elevation of alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase. Abnormal radiological findings included hepatomegaly, gas-filled intestinal loops consistent with gastrointestinal ileus and ascites. Ultrasonographic findings included heterogeneous liver parenchyma, free abdominal fluid and reduced bowel motility. Diagnosis was confirmed by histopathological examination of the liver in all three cases.     

Hepatic lobe torsion in 3 dogs and a cat

OBJECTIVE: To describe the clinical features of hepatic lobe torsions in 3 dogs and 1 cat. STUDY DESIGN: Retrospective clinical study. ANIMALS: Three client-owned dogs and 1 client-owned cat. METHODS: Medical records were reviewed, and information regarding signalment, clinical signs, physical-exam findings, diagnostic tests performed, treatment, outcome, and follow-up was retrieved. RESULTS: Clinical signs existed for 4 hours to 1 week before examination. Signs were nonspecific in 2 animals that did not have an obvious cause for the hepatic torsion. These signs consisted of lethargy (2), polyuria/polydypsia (2), and anorexia (1). In the other 2 animals, signs were suggestive of the underlying cause of the hepatic lobe torsion. In 1 dog, the torsion was associated with a traumatic diaphragmatic hernia. The cat had a concurrent hemoabdomen secondary to a ruptured hepatocellular carcinoma. Bloodwork abnormalities were nonspecific. Twisted liver lobes included the left lateral lobe (2), the caudate lobe (1), and the right medial lobe (1). Surgical resection (2) or repositioning (1) of the affected liver lobe was attempted in the 3 dogs, and was successful in 2. CONCLUSION: Hepatic lobe torsion is a rare problem but has been reported in humans, rabbits, dogs, pigs, a cat, and a horse. The left lateral liver lobe is most frequently affected. This condition may be idiopathic or associated with neoplasia or absence of ligamentous support (congenital or traumatic) to the liver. CLINICAL RELEVANCE: Prompt surgical resection or repositioning of the involved liver lobe can lead to a successful outcome, avoiding the deleterious effects of venous obstruction such as thrombosis and subsequent necrosis.     

Clinical Techniques: Successful Management of Liver Lobe Torsion in a Domestic Rabbit (Oryctolagus cuniculus) by Surgical Lobectomy

This article describes the management of a case of liver lobe torsion in a domestic rabbit, which was presented with lethargy, abdominal pain and a palpable abdominal mass. Laboratory investigations showed anemia, hypoalbuminemia and raised liver enzymes. An exploratory laparotomy revealed torsion and necrosis of the caudate liver lobe. The affected lobe was removed by lobectomy. The rabbit made a rapid recovery and was in good health at a follow-up examination three months later.     

Liver lobe torsion in a dog

Abdominal radiographs of a dog presented for anorexia and vomiting revealed an ill-defined increase in opacity caudal to the stomach and caudal displacement of the small intestines. Ultrasonographs revealed an enlarged liver lobe with vascular thrombosis. Left medial liver lobe torsion was confirmed at postmortem.     

Spontaneous lung lobe torsion in two pugs

Two, young adult, male pugs presented for spontaneous left-cranial lung lobe torsions. Clinical signs associated with these two cases included increased weakness, increased respiratory effort, tachypnea, acute collapse, lethargy, anorexia, and cyanosis. The torsed lung lobes were excised using a thoracoabdominal stapling device without detorsing the lobes. Both dogs recovered uneventfully, and at least one year postoperatively, no clinical abnormalities were noted by their owners. Results of this report suggest that spontaneous lung lobe torsion in pugs occurs and should be a differential diagnosis for pugs with increased respiratory effort, tachypnea, nonproductive cough, acute collapse, cyanosis, and lethargy. Surgical excision may be curative.     

Chronic splenic torsion in a dog with an accessory spleen

A 4-year-old, neutered male, mixed breed Old English sheepdog was presented for evaluation and treatment of anorexia, vomiting, and diarrhea. Presumptive severe pancreatitis was diagnosed based on the referral bloodwork. Abdominal ultrasonography identified a suspected liver lobe torsion based on the presence of a normal spleen. However, an exploratory laparotomy identified a splenic torsion in addition to a grossly normal spleen.Key clinical message:This case demonstrates that a second, potentially large area of splenic tissue (ectopic or accessory) can be present in the dog; therefore, the presence of a normal appearing spleen on abdominal ultrasonography does not rule out splenic torsion.     

Tussive syncope in a pug with lung-lobe torsion

The most common presenting clinical signs of lung-lobe torsion include dyspnea, tachypnea, lethargy, and anorexia. Tussive syncope secondary to lung-lobe torsion has not been documented. This article describes the presentation, diagnosis, management, and outcome of a pug with tussive syncope secondary to lung-lobe torsion.     

Hepatic abscesses in cats: 14 cases (1985-2002)

In this retrospective study, we describe 14 cats diagnosed with hepatic abscesses. The objective of the study was to report the clinical signs, physical examination findings, clinicopathologic findings, and outcomes in affected cats. These findings were then compared with those previously reported in dogs and humans. Clinical signs were vague and included anorexia, lethargy, and weight loss. Only 23% of cats had fever, whereas 31% were hypothermic. Increases in serum activities of alanine aminotransferase and alkaline phosphatase were found in 45 and 18%, respectively, of the 11 cats that had laboratory work performed. Abdominal ultrasound examinations were performed in 7 cats, and abnormalities were found in 71% of them. Four cats had solitary abscesses, all of which were located in the right liver lobes. The other 10 cats had multifocal small abscesses or microabscesses, and all of these cats had clinical signs suggestive of sepsis. Cytologic evaluation of samples obtained by abdominocentesis indicated septic inflammation in 67% of cats in which peritoneal fluid was analyzed. Hepatic abscess cultures yielded polymicrobial growth in 66% of the cats: Escherichia coli was the most commonly cultured organism. Overall mortality rate was 79%. All survivors underwent exploratory laparotomy for partial hepatectomy to resect the abscess followed by medical management. Hepatic abscesses should be considered in cats with signs consistent with sepsis. More routine use of ultrasonography may aid in earlier diagnosis of hepatic abscesses, potentially improving prognosis and outcome.     

Safety and efficacy of oral mirtazapine in New Zealand White rabbits (Oryctolagus cuniculus)

BackgroundOne of the most common presenting complaints in rabbits is decreased food intake and/or fecal output. This can occur as a clinical consequence of pain, anesthesia and systemic or gastrointestinal disease. In conjunction with diagnosing and treating the underlying condition, veterinary care should aim to normalize food intake and fecal output. Mirtazapine is a tetracyclic antidepressant that has appetite stimulating effects in other species. However, studies in rabbits are currently lacking.MethodsNine six-month old, intact (4 male, 5 female) New Zealand White rabbits (Oryctolagus cuniculus) were used in a randomized, blinded, controlled, complete cross-over experiment. Each rabbit received a low-dose of mirtazapine (1 mg/kg), high-dose (3 mg/kg) and control treatment orally once a day for a total of 2 sequential days with a 5- day washout period between treatment groups. Fecal output, food intake and body weight were measured before, during and after treatment.ResultsFecal output was 25% higher (95% CI: 6.3%–46.9%, P= 0.01) on treatment days following high-dose mirtazapine treatment. Body weight was 1.5% higher (95% CI: 0. 5% to 2.6%, P= 0.006) for all groups on the 2 days following treatment compared to baseline. Body weight was reduced by 2.1% (95% CI: -3.6% to -0.6%, P= 0.011) the week following high-dose mirtazapine treatment. Mirtazapine did not have a statistically significant effect on food intake.Conclusions and clinical relevance:Oral administration of mirtazapine at 3 mg/kg once a day resulted in increased fecal output but not a concurrent increase in food intake. Overall, mirtazapine is well tolerated and may be a useful treatment to increase fecal output in rabbits. However, due to a mild reduction in weight following treatment, clinical monitoring is warranted.     

Torsion of the caudate lobe of the liver in the domestic rabbit (Oryctolagus).

Torsion of the caudate lobe was an incidental necropsy finding in three livers of 984 rabbits. The affected rabbits were mature (18-24 months), without a common background, and did not have clinical signs related to hepatic torsion. No lesions secondary to lobar torsion were seen.     

SONOGRAPHIC AND RADIOGRAPHIC CHANGES ASSOCIATED WITH SPLENIC TORSION IN THE DOG

The clinical, radiographic, and sonographic signs in three dogs with splenic torsion are presented. AH dogs exhibited weight loss, anorexia, and lethargy. Splenomegaly was consistent radiographic finding in two dogs and large ill-defined midabdominal mass was seen in one dog. The spleen was easily imaged sonographically in all dogs. Splenic sonography in two dogs showed diffuse, hypoechoic pattern consistent with splenic congestion. Hilar splenic vessels were enlarged on the sonograms of two dogs.     

Torsion of the descending colon in a cow

An acute intestinal obstruction caused by a torsion of the descending colon with incarceration and strangulation of the apex of the cecum was diagnosed in a mature Holstein cow. The clinical signs manifested were acute anorexia, depression, signs of abdominal pain, and absence of feces. Rectal examination revealed a sharp decrease in luminal size of the descending colon and taut bands at that level. The final diagnosis was obtained by exploratory celiotomy. Although surgical correction was attempted, the cow died of acute fecal peritonitis 18 hours postoperatively.

Acute intestinal obstruction caused by torsion of the descending colon in the cow has not been reported in the literature.

     

Spontaneous midlobar lung lobe torsion in a 2-year-old Newfoundland

A 2-year-old, intact male Newfoundland was presented for evaluation of a 1- to 2-day history of coughing, retching, and progressive lethargy. Thoracic radiographs demonstrated right-sided pleural effusion and lobar vesicular emphysema. An exploratory thoracotomy revealed midlobar torsion of the right caudal lung lobe. A partial lung lobectomy was performed, and following surgery, the dog recovered without complications. Lung lobe torsions in dogs typically occur at the hilus of the affected lung lobe. This report documents that midlobar lung lobe torsions occur in dogs and should be considered as a differential diagnosis in cases of lobar vesicular emphysema and pleural effusion.     

Uterine horn torsion in a non-gravid cat

An 11-year-old female domestic shorthair cat with a previous history of having been spayed, presented with signs of abdominal distension, lethargy and anorexia of 1 week's duration. On the basis of radiological and ultrasonographic findings a tentative diagnosis of pyometra was made. Exploratory coeliotomy revealed a 900 degrees left horn uterine torsion along the longitudinal axis. Ovariohysterectomy was performed without correction of the torsion. To the authors' knowledge this is the first case report of uterine torsion in a non-gravid cat.     

Hepatopathy in 4 dogs treated with amiodarone

Amiodarone is a class III antiarrhythmic drug used in dogs with dilated cardiomyopathy and ventricular tachyarrhythmias. Hepatopathy is one of the more commonly reported adverse effects of amiodarone use in people. We describe 4 dogs that developed hepatopathy associated with amiodarone administration; 2 dogs also developed neutropenia. Three dogs had clinical signs of anorexia and lethargy; 1 did not show signs until impaired liver function had developed. Clinical signs or biochemical abnormalities developed 1.5-8 months after amiodarone treatment was started. Clinical signs resolved within 2 weeks of discontinuing amiodarone, but biochemical abnormalities did not resolve for 6-8 weeks. The delay between onset of liver disease and overt clinical signs suggests that serial evaluation of liver enzyme activities following amiodarone use in does is important.     

The associations between culling due to clinical Johne's disease or the detection of Mycobacterium avium subsp. paratuberculosis fecal shedding and the diagnosis of clinical or subclinical diseases in two dairy herds in Minnesota, USA

Our objectives were to identify associations between clinical or subclinical diseases and subsequent culling because of clinical Johne's disease (JD) or the detection of fecal shedding of Mycobacterium paratuberculosis (Map) after 305 days in milk (DIM). A total of 1297 cows from two Minnesota dairies were enrolled in the study. From study cows, fecal samples were obtained prior to calving (close-up period) and after at least 305 DIM or at the time of leaving the herd (sold/dead). Between 3 and 21 DIM, blood samples were obtained for serum betahydroxybutyrate (BHB) and serum total-protein testing. Body-condition score (BCS) was evaluated during the close-up period, between 3 and 21 DIM, and at the end of lactation. The diagnosis time (DIM) of clinical disease events (culling because of JD clinical signs, ketosis, lameness, mastitis, displacement abomasum, injury, metritis, milk fever, pneumonia, and retained placenta) was recorded. Sixty-six cows were culled because of JD clinical signs (CCDJ) with average DIM of 209. CCDJ was associated with event of pneumonia (n=131) (OR=3.0, 95% CI=1.0-6.0) and level of fecal shedding (light: OR=13.0, 95% CI=5.3-30.0; moderate: OR=34.0, 95% CI=13.0-89.0; heavy: OR=66.0, 95% CI=26.0-171.0). Detection of fecal shedding at the end of the lactation (n=79) was associated only with event of pneumonia (OR=2.0, 95% CI=1.0-4.0).     

Intra-abdominal torsion of a neoplastic testicle in a rabbit (Oryctolagus cuniculus) with cryptorchidism

Background: Testicular torsion is a relatively common complication of cryptorchidism in domestic mammals but is currently unreported in rabbits. Case presentation: A 7-year-old Dutch rabbit was examined for sudden anorexia and lethargy. The rabbit was previously diagnosed with unilateral cryptorchidism 5 years earlier; however, the owner declined surgical treatment at that time. Transabdominal ultrasonography showed a structure consistent with an enlarged testis, with decreased echogenicity, and absent blood flow upon color Doppler ultrasonography. After induction of general anesthesia and during preparation for surgery, the patient had an episode of cardiac arrest. After successful resuscitation, bilateral cryptorchidectomy continued as planned. A ventral midline laparotomy was performed and confirmed presence of an enlarged, dark red left testicle torsed on its spermatic cord. The contralateral testicle was atrophic. Both testicles were removed after standard hemostasis. Recovery was uncomplicated. Histopathologic examination revealed a diagnosis of Sertoli cell tumor and extensive hemorrhage and necrosis in the torsed testicle. Conclusions and Clinical Relevance: Based on literature search, this is the first reported case of intra-abdominal torsion of a neoplastic testicle in a cryptorchid rabbit. Early elective cryptorchidectomy before the potential development of life-threating complications may be beneficial in rabbits as in other species.