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.     

MESENTERIC ROOT AND CECAL TORSION IN A DOMESTIC RABBIT (ORYCTOLAGUS CUNICULUS)

A 4.5-year-old female spayed Rex rabbit (Oryctolagus cuniculus) was presented as an emergency case for hyporexia, pigmenturia, and abnormal feces. The rabbit had been treated for intermittent hyporexia with outpatient medical management and over the next 2 months demonstrated intermittent signs of gastrointestinal stasis, which were only partially responsive to aggressive medical management. Serial radiographs demonstrated persistent gas within the cecum as well as left-sided, cranial displacement of the cecum. A partial cecal obstruction or volvulus was suspected but could not be confirmed, as advanced imaging and exploratory laparotomy were declined. Two months following its initial presentation, the rabbit developed acute signs of shock and colic, but arrested prior to emergency evaluation. Postmortem radiographs showed marked generalized gas dilation of the small intestines and cecum. Necropsy revealed a 360° mesenteric root torsion with devitalization of much of the small intestines, with an additional 180° rotation of the cecum. This case demonstrates that mesenteric root torsion occurs in rabbits and is an important consideration in rabbits presenting with acute shock or chronic, intractable gastrointestinal signs.     

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.     

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.     

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.     

Validation of a Technique to Assess Radial Torsion in the Presence of Procurvatum and Valgus Deformity Using Computed Tomography: A Cadaveric Study

Objective— To validate a technique to assess radial torsion with and without procurvatum and valgus deformity using computed tomography (CT).
Study Design— Anatomic study.
Animals— Radii (n=3) from normal dogs.
Methods— Three cadaveric radii were scanned using CT (3 mm slices). Transverse image sections were assessed at the distal and proximal physeal scar parallel to the joint surface in both sagittal and dorsal planes. Anatomic landmarks of the radius were identified and torsion was measured. A hinged Ilizarov circular external skeletal fixator was constructed to create known procurvatum, valgus, and torsional deformities.
Results— Between observers results were highly correlated for calculation of torsion (r=0.972, r²=0.9448, P <.00001). Mean baseline torsion of the radius in the construct was 4.88°. At 20° procurvatum and valgus, mean calculated torsion was 5.07° (confidence interval [CI]=4.6–5.6°). At 20° procurvatum and valgus with 22.5°-induced torsion, mean measured torsion was 25.4° (expected=27.38°; CI=22.7–28.1°). At 40° procurvatum and valgus and 45°-induced torsion, mean measured torsion was 51.1° (expected=49.88°; CI=−49.2 to 53.0°).
Conclusion— Assessment of radial torsion by CT is reproducible and accurate in the presence of procurvatum and valgus antebrachial angular limb deformities in the dog.
Clinical Relevance— Despite complex presurgical planning, current measurements only allow for measurement of valgus and procurvatum deformities in the sagittal and dorsal planes, this method allows for more precise measurements of radial torsion in the transverse plane.     

Torsion of the uterus--a cause of colic in the mare.

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Torsion of the Uterus — A Cause of Colic in the Mare

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Patterns of physiological bone torsion in the pelvic appendicular skeletons of domestic fowl

Femoral, tibiotarsal and tarsometatarsal torsion was measured in 264 domestic fowls. Birds were either a laying strain fed ad libitum, or a broiler strain fed ad libitum or a broiler strain on restricted feed. They were killed at different times up to 24 weeks of age. Femora were normally rotated externally when the transverse axis of the distal articular surface was compared with that of the proximal joint surface. Tibiotarsi were similarly rotated externally but the high incidence of internal torsion in broilers fed ad libitum suggests that internal rotation is pathological. Tarsometatarsi were normally rotated internally. Mild degrees of intertarsal valgus angulation are physiological but asymmetrical angulation and torsion between each limb of individual birds suggests that a pattern of limb dominance occurs in domestic poultry.     

Testicular torsion in the dog: a review of 13 cases.

The clinical and pathological features of testicular torsion in 13 dogs are reviewed. The affected gonads were intra-abdominal in 11 animals, and inguinal and scrotal respectively in two others. In most cases, the torsion appeared to result from neoplastic enlargement of the testis.     

Retrospective analysis of 19 cases of isolated torsion of the splenic pedicle in dogs

Nineteen cases of isolated splenic torsion in the dog were reviewed retrospectively. Perioperative data were anaiysed in order to determine prognostic indicators of morbidity and mortality for animals with this disease. The Great Dane and German shepherd dog were found to be at increased risk for this condition. The historical features of splenic torsion were non-speclflc and included intermittent signs of gastrointestinal disease and abdominal discomfort. Mean duration of malaise was eight days, but 17 dogs were presented because of a rapid deterioration in their condition. Abdominal ultrasound findings assisted in the decision to perform surgery in ail the dogs on which it was performed. Eighteen animals had splenic torsion confirmed at surgery and were treated by total splenectomy. Ail 18 surgically managed dogs survived. Analysis of pre and postoperative data failed to reveal preoperative parameters that consistently predicted postorative complications.     

维生素对种兔繁殖力作用影响的研究与分析

为了研究维生素对种兔繁殖力作用的影响。试验采用新设计的配方饲料同兔场原来采用的常规配方饲料在相同的条件下进行饲喂试验,分析维生素对种兔发情时间、受胎率、产仔胎数、产仔数、断奶仔兔成活率的影响。选用健康繁殖年龄基本相同的种兔100只,分A、B2组,每组50只,公母比例1∶4,A组饲喂常规饲料,B组饲喂试验饲料。试验结果表明,维生素对种兔的繁殖力作用是显著提高的(P<0.01),在试验的4个月时间里,B组母兔发情只数是A组母兔发情只数的2.46倍;B组母兔平均受胎率是A组母兔平均受胎率的1.72倍;B组母兔产仔数是A组母兔产仔数的11.58倍;B组仔兔成活率是A组仔兔成活率的2倍,达到了理想的配种繁殖效果。     

Accuracy of increased large-intestine wall thickness during ultrasonography for diagnosing large-colon torsion in 42 horses

Large-colon torsion is a common cause of colic in horses and has a worse prognosis and higher cost than other causes of surgical colic of the large colon. During large-colon torsion, the colon wall becomes thick due to vascular occlusion. Therefore, we hypothesized that detecting increased colon wall thickness during ultrasonography would be an accurate preoperative test for large-colon torsion. The sample population consisted of 42 horses that were admitted for surgical treatment of colic localized to the large colon. The diagnosis was confirmed at surgery or necropsy examination. Twelve (29%) of these horses were diagnosed with large-colon torsion. Duplicate ultrasonographic measurements of colon wall thickness were made at six abdominal locations and an average measurement was calculated. For four of these six sites, a significant difference (P < 0.005) was detected between horses with and without large-colon torsion. All four tests were moderately sensitive and highly specific for diagnosing large-colon torsion using five decision criteria. Using a ventral abdominal window, a colon wall thickness > or = 9 mm accurately predicted large-colon torsion in eight of the 12 horses (sensitivity, 67%; confidence interval [CI], 36-98%) and correctly predicted that large-colon torsion was absent in 28/28 horses (specificity 100%; CI, 98-100%). Intraobserver repeatability was assessed by evaluating the difference between the first and second measurements obtained, which was < or = 2 mm. Therefore, detecting increased large-colon wall thickness during ultrasonography is a reproducible and accurate preoperative test for large-colon torsion in horses with surgical colic localized to the large colon.     

Splenic torsion in an alpaca

OBJECTIVE: To describe the clinical signs, diagnostic evaluation and surgical management of an alpaca with splenic torsion. ANIMALS: Six-year-old female alpaca. RESULTS: Splenic torsion and uterine torsion were the inciting cause for persistent abdominal discomfort in this alpaca. Rectal examination, abdominocentesis, and transabdominal ultrasonographic findings were suggestive of a splenic lesion. Surgical management involved splenectomy of a necrotized spleen. CONCLUSIONS: Although rare in occurrence, splenic torsion should be considered as a potential cause of abdominal discomfort in alpacas. Splenectomy is a reasonable and successful method of treatment for a devitalized spleen secondary to splenic torsion in alpacas. CLINICAL RELEVANCE: Splenic torsion causes persistent abdominal discomfort in camelids and may be associated with uterine torsion. Rectal examination, transabdominal ultrasound and abdominocentesis are useful diagnostic tools to differentiate splenic torsion from other causes of abdominal discomfort. Splenectomy is an uncomplicated procedure in camelids and has a favorable prognosis.     

Influence of uterine torsion in water buffaloes (Bubalus bubalis) with insights into the hematological and biochemical prognostic values regarding to manual correction

Bovine uterine torsion refers to the rotation of the gravid uterus around its longitudinal axis. It is the dominant cause of dystocia in buffaloes. A total of two hundred and seventeen dystocia’s Egyptian buffaloes were examined, and another twenty were apparently normal at the full term (healthy pregnant group). From the dystocia’s buffaloes, twenty-three percentage (n = 50) was uterine torsion after gynecology inspection at presentation (Ut group) and 5 days after the manual correction (Utc group). The buffaloes with uterine torsion exhibited loss of appetite, constipation, colic, and straining. The incidence of torsion was mostly at first parity that accounting for 50% of cases. Regarding to the pregnancy stage, torsion mostly occurred at full term, where it primarily occurred in buffaloes at 3 years of age. Right-sided torsion ensued in 90% of all cases. The survival rate of the pregnant buffaloes was 90% (45 buffaloes), and 10% (5 buffaloes) was directed to the culling. Regarding to the fetal survival outcome, 30% of fetuses was survived where the other 70% was died. The hematological results denoted leucocytosis in Ut and Utc groups that attributed to neutrophilia, monocytosis, and eosinophilia. Biochemical assessments were denoted an augments in the levels of serum AST, LDH, CPK, creatinine, blood urea nitrogen, progesterone, cortisol, MDA, NO, TAC, blood lactate (bLac), TNF-α, and IL-6. Where there were a non significant fluctuations in the ALT, GGT, calcium, and phosphorus levels in the torsion cases. The significant declines in 17-β-oestradiol, total proteins, albumin, magnesium, and GSH levels in the dams suffering from Ut were observed. The robust elevations in AST (156 ± 3.47) and bLac (16.12 ± 0.18) with severe hypomagnesaemia (2.69 ± 0.15) were evident in 10% of the torsion cases that directed to the culling. This can conclude that robust elevations in AST and bLac with severe hypomagnesaemia are factors denoting a poor prognosis for uterine torsion in the buffaloes.

     

Use of computed tomography and minimum intensity projection in the detection of lobar pneumonia mimicking lung lobe torsion in a dog

A 10‐year‐old female spayed Dachshund was referred with progressive coughing for 1 month. The dog was tentatively diagnosed with right middle lung torsion based on pleural effusion, vesicular emphysema, abruptly ending bronchus in consolidated right middle lung, and no contrast enhancement of the affected lobe on radiography and computed tomography (CT). There was no evidence of torsion upon thoracotomy, and histological examination confirmed lobar pneumonia. The CT images were reevaluated using minimum intensity projection and revealed normal bronchial courses. The minimum intensity projection technique can be to assist in evaluation of the bronchial tree for dogs with suspected lung lobe torsion and other pulmonary diseases.     

Uterine torsion in cattle - frequency, clinical symptoms and theories about the pathogenesis

Aim of the present study was to summarize the available literature about the incidence, frequency, clinical symptoms and ideas as to the pathogenesis of uterine torsion in the cow. MATERIALS AND METHODS: Analysis of the literature using electronic libraries (Pub Med, Medline), German veterinary medicine journals and obstetrical textbooks. RESULTS: Uterine torsion is a very important maternal reason for dystocia as most cases occur during parturition. The post-cervical torsion (combined uterine and vaginal torsion, Torsio uteri and vaginae) is more commonly diagnosed than an intra-cervical or pre-cervical torsion. Torsions to the left occur more frequently than to the right. Clinical symptoms clearly vary depending on the degree of torsion. The frequency in relation to all parturitions is described as between 0.5 and 1%, whereas the percentage of uterine torsions presented to the veterinarian as a reason for dystocia varies between 2.7 and 65%. The pathogenesis of uterine torsion remains unclear; however, general agreement exists that the cow is predisposed to uterine torsion due to its anatomy. It appears that the Brown Swiss is more often affected than other cattle breeds.     

Successive torsion of the right middle and left cranial lung lobes in a dog

This case report describes the torsion of two lung lobes in a dog. The animal was first presented for a torsion of the right middle lung lobe. Following the surgical resection of that lobe, the dog suffered another torsion of the left cranial lung lobe (cranial and caudal segments).     

Effects of heparin treatment on colonic torsion-associated hemodynamic and plasma eicosanoid changes in anesthetized ponies

Large colon torsion frequently is a fatal condition in horses. The purpose of the study reported here was to determine systemic arterial pressure, plasma eicosanoid concentrations, colonic blood flow, vascular resistance, tissue pH, and morphologic features associated with large colon torsion and detorsion, and to evaluate the effects of sodium heparin (80 IU/kg of body weight, IV) treatment on these values. Values were determined in 20 anesthetized ponies that were randomly assigned into 4 equal groups: control; control/heparin; torsion; torsion/heparin. Torsions were created by a 720 degrees rotation of the cecum and colon around their long axes at the sternal and diaphragmatic flexures. After 1 hour of torsion, the torsion was corrected and the colon was allowed to reperfuse for 1 hour. Heparin was administered 30 minutes into the experiment. Parametric data were analyzed (P less than or equal to 0.05), using split-plot analysis of variance, with differences between means evaluated with a modified Bonferroni t test; histopathologic data were analyzed (P less than or equal to 0.05) with a Kruskal-Wallis one-way analysis of variance by ranks. Heparin prevented colonic detorsion-induced hypotension and increases in vascular resistance and thromboxane concentration, and it significantly increased colonic blood flow for 40 minutes during reperfusion. Heparin did not alter prostacyclin concentration or the histologic appearance of the large colon.     

Gastrointestinal Disease in Exotic Small Mammals

Exotic small mammal medicine is a relatively new specialty area within veterinary medicine. Ferrets, rabbits, and rodents have long been used as animal models in human medical research investigations, resulting in a body of basic anatomic and physiologic information that can be used by veterinarians treating these species. Unfortunately, there is a paucity of veterinary articles that describe clinical presentation, diagnosis, and treatment options of gastrointestinal (GI) disease as it affects exotic small mammals. Although there is little reference material relating to exotic small mammal GI disease, patients are commonly presented to veterinary hospitals with digestive tract disorders. This article provides the latest information available for GI disease in ferrets (Helicobacter mustelae gastritis, inflammatory bowel disease [IBD], GI lymphoma, systemic coronavirus, coccidiosis, and liver disease), rabbits (GI motility disorders, liver lobe torsion, astrovirus, and coccidiosis), guinea pigs (gastric dilatation volvulus [GDV]), rats (Taenia taeniaeformis), and hamsters (Clostridium difficile). Both noninfectious diseases and emerging infectious diseases are reviewed as well as the most up-to-date diagnostics and treatment options.