What exactly is liver lobe torsion, and how common is it?

Rabbits have 5 sections, or lobes, of their liver. The lobe on the right is called the Right Caudate liver lobe and is the most likely one to be twisted. The lobe will acutely twist at the base. When it twists this cuts off the blood flow to the lobe and the tissue starts to die. This can be very painful. This causes the liver enzymes to become very high on blood tests. There is also a decrease in the red blood cells, called anemia. Sometimes there is free blood in the belly. The anemia may occur secondary to blood loss if blood is leaking into the belly from the injured lobe, or it could be due to direct damage to liver tissue. We don’t know why rabbits get LLT. It is relatively common. It is getting diagnosed more frequently in the past several years because rabbit vets are getting better at treating rabbits, and are more likely to perform bloodwork and x-rays, and be able to diagnose it. It seems to occur most frequently in healthy middle-aged rabbits.  


What are the symptoms of LLT?

The rabbit will suddenly stop eating and will be lethargic. The temperature may be normal or may be lower than normal. The rabbit may or may not press their abdomen down with pain. The gum color may be pale or white. These symptoms appear the same as a basic GI stasis or bloat. 


How is LLT diagnosed, and treated? Is surgery always needed?

Diagnosis: On bloodwork the rabbit will have elevated liver values and low red blood cells. Sometimes there will also be low platelet numbers. X-rays may show an enlarged liver or decreased detail in the liver area. Definitive diagnosis occurs on ultrasound, the affected liver lobe will be dark and not have blood flow.

Treatment: If the rabbit is not very anemic, is not painful, is not lethargic, has a normal temp and is nibbling on food then they may be able to be treated medically. Medical treatment includes pain meds, intestinal meds, metronidazole liver antibiotic, possibly a second broad spectrum antibiotic, Milk Thistle, SQ or IV fluids, and syringe feeding. The rabbit needs to be closely monitored to make sure the anemia doesn’t worsen. It can take 1-2 weeks on meds for the rabbit to be back to normal. 

If the rabbit is not eating, is painful, or bloodwork looks really bad then it definitely needs emergency surgery. If there is significant anemia then the rabbit will also need a blood transfusion before or during surgery. 

What is the success rate of LLT surgery, and what are the risks?

The success rate is high but depends on how sick the rabbit is as well as how experienced the veterinarian is. If the diagnosis is made quickly and the rabbit goes to surgery within 12-24 hrs then there is a better prognosis. If the rabbit has very low platelets then there may be more risks. They may die during or after surgery from inability to clot or too much clotting, or they may form a clot in their lungs or heart.

If my rabbit is diagnosed with LLT, how long do I have before they need surgery?

If a rabbit has a LLT that is too bad to be treated medically then they should have surgery performed within 12-24 hours of onset of signs. 

Can multiple lobes twist at the same time?

It is uncommon but has been reported. 

What does recovery look like for rabbits with LLT? 

It depends on how sick they are. If they get surgery then they need to be hospitalized for a couple days afterwards. They may be tired, sedate. The veterinarian needs to syringe feed them to get their gut moving again. They will need to be on pain meds, antibiotics and other treatments for at least a week. 

If a rabbit has a mild case and is treated medically they may be able to be sent home sooner, and the owner will need to medicate them for a few weeks and bring them back in for frequent rechecks. 

Is there any way to prevent LLT?

Sadly, no.

What is the chance of recurrence?

Extremely low. 

Are there certain breeds of rabbits more prone to LLT?

Some veterinarians have stated they are seeing it most frequently in lop rabbits. At our hospital we see it in almost all breeds of rabbits and don’t see any one breed overrepresented. 

What is the most common age range of rabbits you see with LLT? 

Usually 3-7yrs old. But recently we had two cases, one was a year old and the other was only 9mos. 

A friend of mine lost her 6 year old rabbit last year to LLT. They did everything right – took her to the emergency vet as soon as she stopped eating, had bloodwork, x rays and a CT scan done. They scheduled the surgery right away and the rabbit made it through just fine. While in recovery a day later, the bunny crashed and passed away. How common is that, and what might have happened to the rabbit?

Most likely the rabbit had a blood clot that traveled to the lungs or heart. 

I wanted to ask Dr Kanfer how we can tell the difference between liver lobe torsion and stasis…. My bun is always twisting his body and rolling over on his back. Is it possible for him to twist his liver doing that? Mahalo!

Stasis and LLT appear similar, the rabbit stops eating and is lethargic. Blood Work will show elevated liver values and anemia, then an ultrasound will give a definitive diagnosis of LLT. 

We don’t know if twisting or binkying causes LLT. Or gas. 

My rabbit had two liver lobe Torsion surgeries before the age of 2. During his second surgery, the doctor noted a grayish color to his liver and suggested he only had 2 months to live. They put him on medication called Sam-E Milk Thistle, and he lived for 10 more months. Peppers passed away last month even though he was showing NO signs of further liver issues or GI stasis. One day he started having seizures and his heart stopped. The doctors don’t know why. My question is there anything we could’ve done to cure the liver lobe torsion and prevent it from returning? What could have caused his liver to do this twice? 

That is unusual. Usually only one lobe is affected. Since your rabbit’s entire liver was discolored, there could have been some other liver disease occurring. Sometimes a biopsy will give more information. There could have been a congenital liver dysfunction, a Coccodia parasitic infection, or a bacterial infection. Milk Thistle and SAM-e are very helpful for liver disease.

Why are Holland lops predisposed to torsion?

We do not know why some rabbits develop a LLT. There could be a genetic cause. Other vets have reported seeing a higher incidence of LLT in lops, but at our hospital we see it in almost all breeds. 

If your bun is diagnosed with torsion – how much time do you have? Do you need to hospitalize your bun?

Rabbits that stop eating should be seen by a rabbit savvy vet within a few hours. They should have x rays and bloodwork done to differentiate if the rabbit has a LLT, a bloated stomach, or just GI stasis. If the rabbit has a LLT they should have surgery performed within 12-24hrs and they need to be hospitalized. 

Why do some exotic vets, even those who see rabbits, misdiagnose torsion?

Many owners cannot afford to pay for bloodwork and x rays, or don’t realize why these tests are so important. Some exotic vets do not keep up with the most recent information. Some vets assume that owners don’t want to spend much money so they won’t even offer x rays or bloodwork. Some  vets don’t realize that an anorectic rabbit may be at risk for death. Some vets don’t have staff that are experienced enough to take x rays or blood on a rabbit. Or they don’t have the ability to run blood work in the hospital or perform an ultrasound.