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Theurer J, Himmelsbach P, Sinzinger W, Hartmann A. Gallbladder torsion in an 11-month-old Labrador Retriever. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:189-193. [PMID: 37567181 DOI: 10.1055/a-2110-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
An intact male Labrador Retriever was presented with signs of an acute abdomen and generalized weakness. Abdominal ultrasonography revealed a distended, horizontally orientated and caudally displaced gallbladder with a thickened wall. Computed tomography (CT) showed an abrupt tapering of the cystic duct in addition to the displacement of the gallbladder.On laparotomy a complete gallbladder torsion was diagnosed. After cholecystectomy the dog made a full recovery. Gallbladder torsion should be considered as a rare, potential differential diagnosis in dogs with an acute abdomen.
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Sheen JC, Vella D, Hung L. Retrospective analysis of liver lobe torsion in pet rabbits: 40 cases (2016-2021). Vet Rec 2022; 191:e1971. [PMID: 35841624 DOI: 10.1002/vetr.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Liver lobe torsion (LLT) in rabbits can be under-recognised and potentially fatal. The clinical features of cases presented to an exotic animal veterinary service in Australia were retrospectively reviewed. METHOD Medical records of confirmed rabbit LLT cases between 2016 and 2021 were reviewed for signalment, clinical signs and findings, diagnostic imaging results, management strategies and outcomes. Variables of interest were analysed for statistical association with outcome. RESULTS A total of 40 rabbits were included. The mean presenting age was 56.2 months (SD 30.5). Neutered males (23/40, 57.5%) were over-represented. Common clinical signs and findings included reduced appetite (40/40, 100%), lethargy (32/40, 80.0%), reduced faecal production (16/40, 40.0%), a doughy distended stomach (20/40, 50.0%), pale mucous membranes (19/40, 47.5%) and hypothermia (17/40, 42.5%). Anaemia and elevated plasma alanine aminotransferase and blood urea nitrogen were common clinicopathologic findings. Computed tomography (CT) was performed in 34 of 40 rabbits, confirming the presence and position of LLT (34/34, 100%), stenosis of the caudal vena cava or portal system (28/34, 82.4%) and increased free peritoneal fluid (29/34, 85.3%). Fifteen (15/40, 37.5%) rabbits were medically managed, and surgical intervention was performed in 23 of 40 (57.5%) rabbits. Overall, 30 of 40 (75.0%) rabbits survived. Surgical intervention did not confer a significant difference in outcome compared to medical management (odds ratio 0.77, 95% confidence interval 0.15-4.10, p = 0.761). CONCLUSION CT can be an invaluable diagnostic modality for rabbit LLT. Favourable outcomes can be achieved in selected cases with medical management alone.
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Affiliation(s)
- Joanne C Sheen
- Sydney Exotics & Rabbit Vets, North Shore Veterinary Specialist Centre, Artarmon, New South Wales, Australia
| | - David Vella
- Sydney Exotics & Rabbit Vets, North Shore Veterinary Specialist Centre, Artarmon, New South Wales, Australia
| | - Lily Hung
- Animalius, Bayswater, Western Australia, Australia
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Picavet PP, Vidal PA, Bolen G, Gommeren K, Noël S. Gallbladder and Liver Lobe Torsion in a Young Cat Presented with Hemoabdomen. J Am Anim Hosp Assoc 2021; 57:247-251. [PMID: 33450017 DOI: 10.5326/jaaha-ms-7090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 11/11/2022]
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.
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Knight R, McClaran JK. Hemoperitoneum Secondary to Liver Lobe Torsion in a Cat. J Am Anim Hosp Assoc 2021; 56:e56102. [PMID: 31841380 DOI: 10.5326/jaaha-ms-6758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 5 yr old male British blue shorthair cat was presented collapsed with hypotension, hypothermia, and cranial abdominal pain. Abdominal ultrasound and abdominocentesis revealed hemoperitoneum and a suspected hepatic mass. Cytology of fine-needle aspirates of the mass was inconclusive, so exploratory celiotomy was performed for diagnostic and therapeutic purposes. An enlarged, hemorrhagic papillary process of the caudate lobe was identified, with twisting of the vasculature at the hilus, so a complete lobectomy was performed using a thoracoabdominal stapler. Histopathology was consistent with liver lobe torsion with no evidence of hepatocellular neoplasia identified. This report describes the first case of hemoperitoneum secondary to liver lobe torsion without evidence of hepatocellular neoplasia in a cat and demonstrates a successful outcome following surgical management with liver lobectomy.
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Affiliation(s)
- Rebekah Knight
- From the Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, United Kingdom (R.K.); and London Vet Specialists, London, United Kingdom (J.K.M.)
| | - Janet Kovak McClaran
- From the Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, United Kingdom (R.K.); and London Vet Specialists, London, United Kingdom (J.K.M.)
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Cordella A, Bertolini G. Multiphase multidetector-row computed tomographic and ultrasonographic findings in dogs with spontaneous liver lobe torsion. Res Vet Sci 2021; 135:192-199. [PMID: 33556649 DOI: 10.1016/j.rvsc.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
Liver lobe torsion (LLT) is an uncommon condition of unknown origin in dogs. Several reports describe the clinical features and outcome, but only few of them include the imaging characteristics of this disease. The aim of this descriptive case series was to describe the ultrasonographic (US) and multidetector-row computed tomographic (MDCT) features of LLT in a group of dogs. Five dogs were included in this single-center descriptive study, having both US, CT and surgical and histological confirmation of LLT available for review. Different US appearances have been found, both hypoechoic and hyperechoic liver lobes and heterogeneous mass-like lesions, with fluid and gas content. At three-phase MDCT examination, LLT appeared as fluid- and gas-filled lesions (consistent with abscess transformation), or as hypoattenuating hypovascular lobes. Two different vascular signs were also described: whirl sign or vascular interruption were seen in all cases, allowing a correct pre-surgical diagnosis in all the cases presented. Multiphase MDCT was a helpful imaging method for the correct pre-surgical diagnosis of LLT in dogs, and its use in the suspected cases is therefore advisable.
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Affiliation(s)
- Alessia Cordella
- Diagnostic and Interventional Radiology Division of San Marco Veterinary Clinic and Laboratory, Veggiano, Padova, Italy
| | - Giovanna Bertolini
- Diagnostic and Interventional Radiology Division of San Marco Veterinary Clinic and Laboratory, Veggiano, Padova, Italy.
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Tallaj KM, Cortes Y, Gannon KM, Fettig AA. Acute liver lobe torsion in a kitten. JFMS Open Rep 2021; 7:2055116921990295. [PMID: 33708412 PMCID: PMC7907942 DOI: 10.1177/2055116921990295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CASE SUMMARY A 10-week-old intact male domestic shorthair kitten presented for an acute onset of lethargy, vomiting and anorexia. An abdominal mass effect was palpable on presentation. Blood work, abdominal radiographs and point-of-care abdominal ultrasound showed severe anemia, decreased serosal detail and abdominal effusion, respectively. Based on the concern for an abdominal organ torsion or ruptured mass, an emergency abdominal exploratory surgery was performed. Torsion of the entire caudate liver lobe was discovered with a secondary hemoabdomen, and a liver lobectomy was performed. The kitten was stabilized and discharged 3 days after surgery. At the recheck examination, 15 days postoperatively, the patient was reported to be doing well. RELEVANCE AND NOVEL INFORMATION Liver lobe torsion is a rare condition previously reported in six other cats; however, this is the first peer-reviewed report in a kitten successfully treated with surgery with no identifiable underlying cause.
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Daggett A, Loeber S, Le Roux AB, Beaufrere H, Doss G. Computed tomography with Hounsfield unit assessment is useful in the diagnosis of liver lobe torsion in pet rabbits (Oryctolagus cuniculus). Vet Radiol Ultrasound 2020; 62:210-217. [PMID: 33340204 DOI: 10.1111/vru.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Abstract
Clinical signs of liver lobe torsion in rabbits are often nonspecific and mimic those that are also generally detected with gastrointestinal stasis. Nonspecific clinical signs may result in pursuit of full-body imaging such as computed tomography (CT). The aim of this multicenter, retrospective, case series study was to describe CT findings of liver lobe torsion in a group of rabbits. Computed tomography studies of six rabbits with confirmed liver lobe torsion by surgery or necropsy were evaluated. The caudate liver lobe was affected in six out of six rabbits and was enlarged, rounded, hypoattenuating, heterogeneous, and minimally to noncontrast enhancing, with scant regional peritoneal effusion. Precontrast, mean Hounsfield units (HU) of the torsed liver lobe (39.3 HU [range, 24.4-48.1 HU]) were lower than mean HU of normal liver (55.1 HU [range, 49.6-60.8 HU]), with a mean torsed:normal HU ratio of 0.71 (range, 0.49-0.91). Postcontrast, mean HU of the torsed liver lobe (38.4 HU [range, 19.7-48.9 HU]) were also lower than mean HU of normal liver (108.4 HU [range, 84.5-142.0 HU]), with a lower postcontrast mean torsed:normal HU ratio of 0.35 (range, 0.14-0.48) compared to precontrast. Mean HU of torsed liver lobes had little difference pre- and postcontrast (postcontrast HU 1.0 times the average precontrast HU [range, 0.81-1.1]), and contrast enhancement of the torsed liver lobes was on average 50% lower than in normal liver. Liver lobe torsion should be considered in rabbits with an enlarged, hypoattenuating, heterogeneous, minimally to noncontrast enhancing liver lobe, particularly the caudate lobe, and scant regional peritoneal effusion.
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Affiliation(s)
- Alexis Daggett
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Samantha Loeber
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Alexandre B Le Roux
- Department of Diagnostic Imaging, The Animal Medical Center, New York, New York
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Grayson Doss
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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Sumping JC, O'Connell EM, Mortier J. Computed tomographic and clinical findings in a dog with suspected liver lobe torsion, secondary disseminated intravascular coagulation and multiorgan infarction. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Jeremy Mortier
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
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Skytte D, Schmökel H. Suspected Gallbladder Torsion in a Juvenile German Shepherd Dog. J Am Anim Hosp Assoc 2019; 55:e55603. [PMID: 31525094 DOI: 10.5326/jaaha-ms-6754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 11 mo old intact female German shepherd dog was presented with a 1 day history of vomiting, abdominal pain, and lethargy. A complete gallbladder torsion with secondary bile leakage was diagnosed during exploratory laparotomy. The dog underwent cholecystectomy at the clearly demarcated border of the viable cystic duct and recovered with no complications. Torsion was possible as a result of the complete absence of normal connective tissue attachments to the hepatic fossa, in human medicine called a wandering gallbladder. No other abnormalities were found on complete abdominal exploration. Very few cases describe torsion of the cystic duct as a cause for extrahepatic biliary disease and secondary bile peritonitis in dogs.
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Affiliation(s)
- Ditte Skytte
- From Evidensia Specialist Animal Hospital, Strömsholm, Sweden
| | - Hugo Schmökel
- From Evidensia Specialist Animal Hospital, Strömsholm, Sweden
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McHenry KM, Dujowich M, Oliveira CR. What Is Your Diagnosis? J Am Vet Med Assoc 2017; 250:505-507. [PMID: 28207319 DOI: 10.2460/javma.250.5.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vilalta L, Espada Y, Majó N, Martorell J. Liver Lobe Torsion in a Domestic Ferret (Mustela putorius furo). J Exot Pet Med 2016. [DOI: 10.1053/j.jepm.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Khan Z, Gates K, Simpson SA. Bicavitary effusion secondary to liver lobe torsion in a dog. VETERINARY MEDICINE-RESEARCH AND REPORTS 2016; 7:53-58. [PMID: 30050837 PMCID: PMC6055766 DOI: 10.2147/vmrr.s83608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We described the diagnosis and successful treatment of pleural and peritoneal effusion secondary to liver lobe torsion in a dog. A 12-year-old female spayed Borzoi dog was referred for heart failure. Emergency room thoracic and abdominal ultrasound showed a large volume of pleural effusion with mild peritoneal effusion and an abdominal mass. Pleural fluid analysis classified the effusion as exudative. A complete ultrasound revealed mild peritoneal effusion and decreased blood flow to the right liver lobe. Other causes of bicavitary effusion were ruled out based on blood work, ultrasound, echocardiogram, and computed tomography. The patient was taken to surgery and diagnosed with caudate liver lobe torsion and had a liver lobectomy. At the 2-week postoperative recheck, the patient was doing well and there was complete resolution of the pleural effusion. Liver lobe torsion is a rare occurrence in dogs and can be difficult to diagnose. Clinical signs are nonspecific for liver lobe torsion and patients may present in respiratory distress with significant pleural fluid accumulation. When assessing patients with pleural and peritoneal effusion, liver lobe torsion should be considered as a differential diagnosis.
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Affiliation(s)
- Zaheda Khan
- Emergency and Critical Care, Animal Specialty and Emergency Center, Los Angeles, CA,
| | - Kathryn Gates
- Emergency and Critical Care, Advanced Critical Care, Emergency and Specialty Services, Culver City, CA
| | - Stephen A Simpson
- Emergency and Critical Care, Southern California Veterinary Specialty Hospital, Irvine, CA, USA
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Jackson AE. In this issue - January/February 2012. Aust Vet J 2012. [DOI: 10.1111/j.1751-0813.2011.00889.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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