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.     

Left lateral and left middle liver lobe torsion in a Saint Bernard puppy

A 5-month-old, male Saint Bernard was presented for acute collapse and abdominal discomfort. Significant findings were a cranial abdominal mass, hemorrhagic abdominal effusion, anemia, and disseminated intravascular coagulation. An exploratory surgery revealed torsion of both the left lateral and middle liver lobes, a condition that has not been previously described in the veterinary literature. Torsion of one or more hepatic lobes is a rare condition but should be considered as a differential diagnosis for acute abdomen syndrome in both young and mature dogs. Early diagnosis and prompt surgical intervention may be curative.     

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.     

Hepatic lobe torsion in a horse

A 4-year-old Belgian mare was presented with a 1-week history of fever, suspected of being caused by peritonitis. The mare died before the diagnostic procedures had been completed; postmortem examination revealed torsion of the left medial lobe of the liver, resulting in diffuse necrosis of liver tissue and severe peritoneal effusion.     

Radiographic,ultrasonographic, and computed tomographic characteristics of an accessory liver lobe in a cat

A 5‐year‐old male Norwegian Forest cat presented with increased hepatic serum biochemical parameters. Abdominal radiography showed an oval cranioventral mass and ultrasound revealed a mobile mass attached to one hepatic lobe. Computed tomography (CT) confirmed that the mass was attached to the right medial liver lobe. Differential diagnoses were an accessory liver lobe, benign neoplasia, and focal nodular hyperplasia. The mass was removed and histopathology confirmed the mass to be normal liver tissue. Accessory liver lobe should be included in the differential diagnosis of a mobile cranial abdominal mass with a similar ultrasonographic or CT appearance to the liver.     

Lung lobe torsion associated with chest wall defects in a dog

An 8-year-old, spayed, female poodle presented with exercise intolerance, lethargy, respiratory distress, retching, hyporexia and diarrhoea. Thoracic radiographs revealed increased opacity in the left cranial thoracic region. The fifth and sixth ribs appeared to be bulging cranially to caudally, and CT and surgical exploration confirmed the presence of a thoracic wall defect in that area. CT showed abrupt occlusion of the bronchus that branches into the left cranial lobe and consolidation of the caudal segment of left cranial lung lobe, which led to the diagnosis of lung lobe torsion. A thoracotomy was performed, the twisted lung lobe was surgically excised, and the defect in the thoracic wall was repaired. Respiratory distress gradually improved after the surgery, and there were no identified complications within the 2-year period following the procedure. Based on our literature search, this is the first reported case of lung lobe torsion caused by a thoracic wall defect in a dog.     

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.     

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

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.     

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.     

Increased left lung consolidation in turkey cholera related to larger left pulmonary artery

After necropsy of the surviving turkeys in a comparative vaccine study for fowl cholera, in the turkeys with only one lung lobe consolidated, a significantly (P < 0.01, chi square test) higher number of turkeys were found with a consolidation of the left lung lobe than with the right lung lobe. When the circumferences of the left and right pulmonary arteries 0.5 cm rostral from the bifurcation were measured and converted to cross-sectional area, the left pulmonary artery had an average area of 29.6 +/- 2.8 mm2, and the right pulmonary artery had an average area of only 22.9 +/- 2.8 mm2, which was nearly one-fourth smaller. This finding suggests that the left lung lobe receives more blood than the right lobe and that, during an acute Pasteurella multocida septicemia, it would receive more of this organism than the right lung lobe.     

On the morphology of the liver in the two-humped camel (Camelus bactrianus)

The liver of a two-humped camel (Camelus bactrianus) was examined by means of gross anatomy and histology. The liver appeared characteristically as an enlarged triangle in visceral aspect, and showed the following lobation: the left lateral and medial lobes, the right lobe, the caudate lobe and the quadrate lobe. These findings were similar to those for the one-humped camel. Histologically, a distinct lobulation, a typical arrangement of the interlobular connective tissue, and the trias was confirmed.     

Ataxia and weakness as uncommon primary manifestations of hepatic encephalopathy in a 15‐year‐old trotter gelding

A 15‐year‐old trotter gelding was evaluated because of an acute onset of ataxia in all 4 limbs. There was no known history of trauma. The gelding showed grade 2/5 ataxia in all 4 limbs, which was localised after clinical neurological examination to the cervical vertebral spinal cord. Initial therapy consisted of oral anti‐inflammatory doses of prednisolone and antimicrobial treatment with potentiated sulphonamides. The ataxia progressed to grade 3/5 at Day 10 of hospitalisation. Additionally, the horse was slightly depressed and showed spontaneous yawning during examination. Facial sensation was blunted. Blood chemistry revealed a marked elevation of liver specific enzymes and blood ammonia levels. Transcutaneous abdominal ultrasonography revealed hepatomegaly. Due to a guarded prognosis, the horse was subjected to euthanasia. At necropsy the left lateral liver lobe was markedly enlarged and showed a firm texture, whereas the cranial part and the right and quadratic liver lobe displayed a severe and diffuse atrophy. Histopathologically, the left lateral liver lobe revealed a moderate to severe cirrhosis with a severe, diffuse hepatocellular iron‐accumulation. Increased numbers of Alzheimer type II astrocytes in the cerebral cortex and cerebral white matter vacuolisation were indicative for encephalopathy. These findings were interpreted as haemosiderosis and cirrhosis of the liver with consecutive hepatic encephalopathy. Aetiologically, haemosiderosis should be considered as a cause of liver cirrhosis with consecutive hepatic encephalopathy. Although hepatic encephalopathy in horses usually presents with predominating cerebral signs, it has to be taken into account as a differential diagnosis in cases of acute onset generalised ataxia.     

Hepatic lobe torsion in 3 dromedary camels

Hepatic lobe torsion is a rare condition in domestic animals. Clinical signs are variable, with some cases remaining subclinical and others resulting in death. Most cases are diagnosed either by laparotomy or during postmortem examination. During postmortem inspection of 670 slaughtered dromedary camels, hepatic lobe torsion of the quadrate lobe was detected in 3 adult female camels. Clinical signs had not been noted on antemortem veterinary inspection, and hepatic lobe torsion was likely an incidental finding. Histologically, the affected liver lobe exhibited severe hepatocellular loss with replacement by fibrous connective tissue. When investigating abdominal pain in camels, veterinarians should include hepatic lobe torsion in the list of differential diagnoses.     

Unusual congenital pulmonary anomaly with presumed left lung hypoplasia in a young dog

A seven‐month‐old, entire, male miniature schnauzer dog was referred with acute vomiting, inappetence and depression primarily as a result of a gastric foreign body (pine cones). During investigations, thoracic radiographs revealed increased volume of the right lung lobes, deviated cardiomediastinal structures and elevation of the heart from the sternum. Thoracic computed tomography revealed left cranial lung lobe hypoplasia and extension of the right cranial lung parenchyma across the midline to the left hemithorax. Branches of the right pulmonary vessels and bronchi also crossed the midline and extended to the left caudal lung lobe. These findings suggested that the right and left lungs were fused. In humans this finding is consistent with horseshoe lung, which is an uncommon congenital malformation. To the authors’ knowledge, this case represents the first report of such a pulmonary anomaly in a dog.     

Hepatic Lobe Torsion as a Cause of Colic in a Horse

A 14-year-old Arabian gelding was examined for colic. An exploratory celiotomy was subsequently performed and the left lobe of the liver was found to be twisted. The lobe was resected using a TA-90 surgical stapling instrument. Histologic examination of the resected liver indicated portal vein and sinusoid dilation and congestion with blood. There were focal areas of necrosis and bacterial cocci and rods throughout the section. The histologic findings were consistent with hepatic lobe torsion. After surgery, the horse was treated with broad spectrum antibiotics, anti-inflammatory drugs, heparin, and intravenous fluids. The horse recovered without complications, although serum liver enzymes remained elevated for more than 1 week after surgery. Seven months after surgery the horse showed no adverse affects from the disease.     

Usefulness of CT imaging for segmental lung lobe torsion without typical radiographic imaging in a Pomeranian

A 3-year-old, intact female Pomeranian presented with a 1-month history of coughing. Thoracic radiography showed focal infiltration of the left cranial lung lobe and widening of the cranial mediastinum. Subsequent computed tomography revealed torsion of the caudal segment of the left cranial lung lobe, which was confirmed by exploratory thoracotomy. There was no apparent underlying etiology for the condition. To the authors’ knowledge, this is the first report of lung lobe torsion in this breed and the first detailed CT imaging report for segmental lung lobe torsion.     

Laparoscopic left hepatectomy in swine: a safe and feasible technique

A purely laparoscopic four-port approach was created for left hepatectomy in pigs. A polyethylene loop was placed on the left two hepatic lobes for traction and lift. Next, penetrating ligation of the lobes using of a double row of silk sutures was performed to control bleeding. A direct hepatic transection was completed using a monopolar hook electrode without meticulous dissection of the left hepatic vein. The raw surface of the liver was coagulated and sealed with fibrin glue. Lobes were retrieved through an enlarged portal. Laparoscopic hepatic lobectomy was completed in all pigs without the use of specialized instruments and with a mean operative time of 179 ± 9 min. No significant perioperative complications were observed. The average weight of each resected lobe was 180 ± 51 g. Complete blood count as well as serum organics and enzyme levels normalized after about 2 weeks. During necropsy, adhesion of the hepatic raw surface to the gastric wall and omentum were observed. No other abnormalities were identified. This minimally invasive left hepatectomy technique in swine could serve as a useful model for investigating liver diseases and regeneration, and offer preclinical information to improve hepatobiliary surgical procedures.