liver torsion

[Lagomorphic]

My Alex was diagnosed with liver torsion today.  I did a search of the forums and found bits of info here and there but wanted to see if I could gather info here in one thread.  A couple of weeks ago, Alex just started acting not quite right.  He was still eating, drinking, and pooping great, and he got excited for meals and new hay in the litter box etc.  But he was sitting hunched up, and I hadn’t seen him all stretched out and relaxed.  He had also been spending time alone in his Cottontail Cottage, which is often where he goes when he isn’t feeling well, rather than snuggling up with his girlfriend Clementine.  He also seemed disengaged, not bright-eyed and seeking me out, not really wanting to be petted.  No grinding teeth or anything though.

I took him to my (rabbit-savvy) vet, where she felt him all over and took blood and x-rays.  He definitely had pain where his liver is and his liver enzymes were somewhat elevated. She didn’t see anything on the x-ray and referred me to another vet for an ultrasound.  She also gave me metacam.  I couldn’t get in with the other vet for another week, but Alex really seemed to improve with the metacam.  I feel like I saw improvement every day, he just started becoming more like himself, and I saw him laying all stretched out.

I saw the other vet today, and she repeated the labs and x-ray first.  He still had pain around his liver and elevated liver enzymes (no change from last week).  And she could see what was probably the liver torsion on the x-ray.  It was the smallest part of his liver that had likely twisted.  An ultrasound would definitely prove it, but she didn’t feel like it was necessary since all of the other signs pointed to torsion.

She felt that since Alex has done so well this far, it probably makes most sense to continue with the metacam and keep an eye on him.  If he was going to have any complications (including fatal ones!), he would have had them already.  And the fact that his liver enzymes hadn’t increased over the week was encouraging.  And of course, surgery has risks of its own!  

So now I’m just watching and waiting (and giving metacam).  Alex is probably 7-8 years old (rescue), so his age isn’t in his favor.  He’s definitely a fighter though!

[Lagomorphic]

This is an excellent post I found from BarbaraC I wanted to add as a resource here.

8/05/2015 9:01 PM         

Hi mijOok. Jerseygirl asked me to reach out to you because my bunny Finnegan recently recovered from liver torsion.

It started with Finn not eating and cowering in a corner of his condo. Finn is the type of bunny that comes running to us when it is time to eat and scarfs down his veggies, so I immediately knew something was wrong. I gave him Critical Care for about 12 hours and treated for gas, praying that that was all it was. When he didn’t get better by the morning I took him to the ER at Angell Memorial. I mentioned intestinal torsion to the vet since I had just read a story on budget bunny about Rocky who had passed away from this and Finn seemed to have all the same symptoms. The vet didn’t suspect this but did suspect liver torsion because his abdomen was tender in the spot where his liver is. However, she was not an exotics vet so I paid the extra to have a consult done. The vet that saw him was a former resident and he had several interns look at him as well. Apparently, they could actually feel the torsion. I’m told that this is fairly uncommon.

Any way, they had drawn blood to check for elevated liver enzymes and this came back positive. The vet then told me that the next step was an ultrasound to confirm the torsion. This was going to be up to $500. Based on the fact that I had ruled out surgery, $2500-4000, since the blood tests had come back basically confirming that it was a liver issue and that all the clinical signs pointed to a liver torsion, I chose not to have the ultrasound. There was no benefit to it. I actually had to argue a little with the vet on this but in the end she agreed that if I wasn’t going to opt for surgery there would be nothing gained from putting him through another test. The treatment was going to be the same either way, supportive care at home.

After I got home I was torn about whether or not I made the right choice opting out of surgery. So I scoured the internet for info. I hadn’t yet joined this forum. What I found were a few anecdotal stories from owners who had all chosen surgery who’s bunnies had recovered and a clinical paper written by a vet at Angell Memorial that did a study of 16 rabbits over 5 years. 9 underwent surgery and 7 were treated with supportive care. Of the 9 that had the surgery all 9 had positive long term outcomes. Of the 7 that received supportive care only 3 survived. You can imagine how conflicted I was with my decision. However, at my followup visit with my vet, who is also a resident at Angell Memorial and a bunny owner himself, he told me that we had made the right decision. Not just because it had a happy ending but also because he has seen both good and poor ourcomes from surgery. I learned that rabbits have have extremely fibrous anatomies and that surgery on them has its own risks. In his experience the surgery has a high rate of failure due to complications and given that we had prior experience with providing supportive care to a sick bunny we were in a good position to choose this option.

He also told me that when he was going to school at Cornell they learned about liver torsion but no one had ever actually seen a case of it, that it is almost exclusivley diagnosed in Boston/New England. This may be because it is somewhat rare and vets don’t even know to look for it and since there was a clinical paper written on th3 subjext by a vet at Angell Memorial they are a lot more conscious of it up here.

You can find an excerpt of the article here http://www.exoticpetmedicine.com/ar…9/abstract

Supportive care consisted of giving him Critical Care until he started to eat on his own, pain meds and GI motility meds for 1 week. What you are hoping for is that the liver will scar over where it is twisted and the affected lobe will shrivel up. After one week he was considered fully recovered. The risk during this time is that the twisted lobe will untwist and flood the body with fatal toxins.

I’m so sorry you are going through this with Simba and I am sending you good thoughts. If you have any more questions about this please feel free to reach out to me either through this thread or on a PM. Unfortunately I recently lost a bunny to E Cuniculi so I have more experience than I ever wanted with providing care for sick bunnies.

[Lagomorphic]

And I found an article about liver torsion in rabbits (I think it’s the one BarbaraC mentions).  It’s too big to attach as one article so I uploaded it in Part 1 and Part 2.  Here’s Part 1.

[Lagomorphic]

And here’s Part 2 of the article.

[Lagomorphic]

Alright, enough from me. Does anyone else have any info about liver torsion?  Thanks!

[Lagomorphic]

Well, Alex isn’t looking so good now.  He wasn’t great last night, hiding in his Cottontail Cottage after dinner (which he got excited for and ate, although he did leave a few pellets that he ate later.  He did eat all his greens at dinnertime).  I attributed this to the stressful day of going to a new vet who poked and prodded him right where he hurt (she also identified arthritis in his spine).

But this morning he was the same:  excited about breakfast, ate most but not all pellets, ate all greens then hid in his Cottontail Cottage.  His girlfriend Clementine is worried about him.  She was hanging out in the litter box by the cottage, which is the box she usually spends the least time in.  I’m at work now, but I’m hoping I can take off early to keep an eye on him . . .

[Bam]

How is he doing today?
It doesn’t seem like our members have a lot of experience with liver torsion.

[redbunbun]

I don’t have any experience with liver torsion, but I do have experience with a sick bunny – it’s great that he’s eating, and even going so far as to be excited about food! That would, to me, suggest that even though he’s feeling a bit crummy in general, he’s not in too much pain, which is always a hopeful sign. Rabbits are so prone to going off their feed, which is devastating for an already ill rabbit’s health.

Keep us updated, sending a lot of vibes for poor Alex!

[LittlePuffyTail]

Sorry to hear Alex is unwell. I don’t have any info but want to send some ((((Feel Better))) Vibes for him.

[Lagomorphic]

Thanks for the vibes! He’s looking much better now. I guess it took him a day to recover from the different vet? (We were there for 3 hours and she poked and prodded him more, didn’t use midazolam for the x-ray like our usual vet, and they didn’t have quite the bedside manner our usual vet has). In fact, this morning, it was chilly in my house, which he loves, and he was running around and even did something that kind of resembled a binky. So I think he’s on the mend.

I do think liver torsion is pretty rare. And I wonder if most buns who have it also usually have GI stasis, so they get treated for the stasis (which usually includes a pain med). If it’s a small part of their liver that twisted like Alex’s, by the time they recover from the stasis, they may have recovered from the liver torsion too. Not everyone has a vet school in their town with vets that know to look for liver torsion.

Hopefully he’ll continue to do well!  My vet is going to check his liver enzymes again in a few weeks just to make sure, and then probably lower his dose of metacam.  He’ll stay on a low dose due to his arthritis.  He’s already been on the Oxbow Joint Support supplement – I’ve suspected he’s had arthritis for a couple of years.

[BarbaraC]

Hi Lagamorphic. Glad to hear Alex is doing much better. When Finn had this same thing the vet told me it takes between a week and 10 days to be considered out of the woods. By that time the liver should have scarred over sufficiently to prevent any of the toxins from the atrophied portion flooding into his system. So it sounds like he should make a full recovery.

When I was going through this with my bunny I too was unable to find many resources on it and most of the first hand accounts from bunny owners were ones in which they chose to have the surgery. Since I had opted to not put him through this I was at a loss trying to find information about what the expected outcome would be with just supportive care. Unfortunately, I had not yet discovered this forum.

Again, I am so happy to hear Alex is recovering and I wish him many more happy and healthy bunny years!

[Lagomorphic]

I got on the forum today, so I figured I’d give an update here. Alex passed away a couple of months ago. He was fine (although he was never quite 100% after this liver torsion), and then one Monday morning he didn’t finish his breakfast. He very quickly went downhill. I took him to my vet who told me to go to the emergency vet for an ultrasound. It looked like he had a tumor on his liver, plus he had another area that seemed painful (another tumor?), and there was something they could see in his eye. He was failing fast and was put down the next morning. I’m not sure if there’s relationship between liver torsion and cancer, or if it really wasn’t torsion in the first place . . .

[Bam]

I’m sorry to hear about Alex. I don’t know enough about live live torsion to be able to have any idea about whether the torsion made him prone to liver cancer or the other way around -or if it was cancer all along.
It’s very sad.
Thank you for the update.
Binky Free Alex

[LittlePuffyTail]

I’m so very sorry to hear you had to say goodbye to you bun.

((((Binky Free Alex))))

[Q8bunny]

From the reading I’ve done and my studies with my bun’s former vet, liver torsion is indeed rare and as such often misdiagnosed (or not diagnosed at all). I imagine establishing a link between this condition and cancer would take a lot more case studies which would obviously require a lot more known cases.

I am truly very sorry you lost Alex. (((Binky free, little one.)))

[Lagomorphic]

Thanks everyone. He was definitely a special boy.

[LitleParks]

I am sorry about Alex – only recently i experience what is like to loose such a magical friend. I hope is OK for me to share my story, i don’t know where else to go for support.

On Wednesday i got home from work and Parks refused his dinner – I phoned his vets straight away and they took him in for the night thinking all he had was accumulated gas, they gave his medication and kept an eye on him over night (He had this once before and came home the next morning so I was not worried), Thursday morning they said they would keep him until the night as he still wasn’t eating nor pooping, by then i had became worried. Thursday night they told he still wasn’t eating but it could have been because of the stress different environment (Last time he was fine with being at the vets so i should have know there was something more).

I took him home that night and within an hour he was completely flat, couldn’t even stand up, i rushed him back and all the vet did was say that she would keep him in the same medication and could not promise me he would be OK during the night. She kept saying that there was nothing more they could do. I begged her to take an x-ray to make sure there was nothing blocking his tummy, she did and all she said she could see was gas. He stayed there again and i kept on calling every 2 hours throughout the night for an update – Friday morning the morning Vet phoned me and said they could either try to do other tests themselves (Why hadn’t they done this before?) or i could take him to a bunny specialist, so I took him to the specialist straight away – He looked better in the morning, not great but he was standing and awake. Arriving there she just made me feel so confident that he was going to be ok, she really new what she was doing – after several tests he became flat again – she said she was certain that he had liver torsion and took him to surgery straight away but unfortunately by then he was too weak and did not handle the anesthesia.

I thought his local vets new what they were doing – i never even imagined there were bunny specialists. I should have know, i should have done my on search, i should have taken him a lot sooner. I was meant to take care of him and i failed him.

I am 29, i live by myself and have being a bit of a loner since my parents passed away on my late teens. Parks brought so much happiness into my life in the 18 months that we lived together – I was always so happy to come home after work because i knew he was going to be there for me and i failed him . Has anyone been in a similar situation?

I never been through this with a pet, you expect your vet to know what they are doing. I miss him so much, I never thought a bunny could bring so much joy into my life, they are truly wonderful pets.

[Bam]

LitleParks, thank you for sharing your story. I’m so sorry you lost Parks.

Rabbit vets are exotics vets – they have extra training with exotics and even though rabbits might not seem overly exotic, they are cathegorized as such. It’s kind of confusing for pet owners because exotics makes you think of lizards and parrots etc. But there are also big differences in the level of rabbit knowledge between different ecotics vets – to an extent depending on what type of patients they’ve mostly been dealing with.

It really is tough to loose a rabbit.

If you want to you can make a Rainbow post for Parks in the Rainbow Bridge-section. It sometimes helps a little bit to make a little picture-album (on Flickr or Photobucket f ex) – even if you will cry while you are making it.

[LitleParks]

Thank you for responding Bam,

I should have know that, he was telling me that he wasn’t OK and i didn’t try hard enough.

I will make a rainbow post – thank you for the suggestion.

[Bam]

LitleParks, try not to judge yourself so hard. You took him to a vet straight away. The most common problem with a bunny that won’t eat is gas or a blockage, you had his tum x-rayed. The vet gave you insufficient information and waited too long until she suggested a rabbit-specialist vet.

I do know the feeling though. We humans always think we could have done more, ought to have done more for those in our care. That doesn’t mean it’s true.

[LitleParks]

Bam,

Thank you for your words of comfort. You promise to take care of them and if you feel like you failed somehow the pain becomes unbearable. Its also very hard when you are told “just get another one” or “is just a rabbit”. I feel for this people that were never able to make such a beautiful connection with such a unique animal.

I would like to think that it was his time, I learned a lot from him and I will always be thankful for the time we spent together.

[Author]

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