Liver Lobe Torsion in Rabbits: What It Is and What to Do
This article is based on Dr. Jeremy Nguyen's Vet Set talk at Bun Chia Burrow, July 26, 2026. Dr. Nguyen is Medical Director and Emergency + Exotic Veterinarian at Veterinary Emergency Group (VEG), Costa Mesa.
Want to watch the talk? Link coming soon!
Liver lobe torsion is not a condition most rabbit parents know to look for - until they are sitting in an emergency room at midnight trying to understand why their rabbit crashed so suddenly. Dr. Jeremy Nguyen, emergency and exotic veterinarian at VEG Costa Mesa, presented on liver lobe torsion at BCB's July 2026 Vet Set because it is one of the most critical situations a rabbit parent can face - and one of the most important to recognize early.
This article summarizes what he covered: what liver lobe torsion is, why it happens, what it looks like, and what treatment actually involves.
What the Liver Does in Rabbits
The liver performs the same core functions in rabbits as in other mammals: metabolism, digestion support, and detoxification through the bloodstream. There is one notable difference - rabbits produce approximately seven times more bile than cats and dogs. This is directly related to their hindgut fermentation system, which requires significantly more bile to keep up with the cecum's demands.
The rabbit liver is divided into several lobes: left lateral, left medial, right lateral, right medial, and the caudate lobe with its caudate process. For the purposes of liver lobe torsion, the most important lobe to know is the caudate lobe.
What Liver Lobe Torsion Is
Liver lobe torsion means exactly what it sounds like: a lobe of the liver twists on itself. As Dr. Nguyen described it, this is similar to a GDV (gastric dilatation-volvulus) or bloat in a dog - an organ twisting on itself, cutting off its own blood supply, and causing rapid systemic deterioration.
The caudate lobe is involved in 80-90% of cases. The reason is anatomical: unlike other lobes, the caudate lobe has minimal attachments to surrounding structures. It essentially floats, making it is susceptible to rotation in a way the other lobes are not. Left lobe torsion has been documented but is significantly rarer.
Why It Happens
The honest answer is that in most cases, it happens without warning and without a clear precipitating cause. A rabbit can be eating normally, acting sassy, and completely fine - and the next morning be in critical condition.
Predisposing factors that have been associated with liver lobe torsion include abdominal trauma (fights and/or falls), underlying liver disease or gallbladder issues, and other conditions that affect liver structure and function. Liver cancer is also a predisposing factor - it compromises liver function and makes the surrounding tissue less stable, which can increase torsion risk and make surgery significantly more complex if it does occur.
But for the majority of cases, it is not predictable and not preventable in any specific way at home. The general recommendations, managing stress, maintaining appropriate diet, minimizing GI stasis risk, are the same recommendations that support overall rabbit health.
What It Looks Like: Signs to Watch For
The early signs of liver lobe torsion overlap significantly with GI stasis, which is one of the reasons it gets missed or delayed. A rabbit who fails the treat test, stops eating, reduces defecation (fecal output/pooping), withdraws from their bonded companion, hides, and hunches is showing signs that could indicate either condition. This is why getting to a rabbit-savvy exotic or emergency vet quickly matters so much, the distinction between stasis and something more serious requires clinical assessment.
The more severe signs (ones that indicate immediate emergency) include
a rabbit laying on their side rather than in a normal sternal position
collapse
labored breathing
If you see any of these, do not wait! Go to your vet immediately.
Mucous membrane color is an important home assessment tool. Dr. Nguyen recommended becoming familiar with your rabbit's normal eye tissue and mucous membrane color on a calm, healthy day - because in a torsion, these can turn significantly pale or even blue.
To check: gently pet your rabbit on the head and look at the tissue around the eye and the inner corner. Nose color and tongue are also useful if you can get a look. Some rabbits run naturally paler than others, which is why knowing your rabbit's specific baseline matters. In severe shock, these tissues can turn almost sheet white. In extreme cases, extremities can turn blue.
Temperature is the other critical home indicator. As the condition progresses, a rabbit in liver lobe torsion will go into shock - the body redirects blood to core organs, and peripheral temperature drops. Dr. Nguyen has seen temperatures drop to 91°F-90°F and below in hospital. Ears go cold. Legs go cold. If your rabbit's temperature is dropping into shock territory, this is an immediate emergency. Know your rabbit's normal temperature (BCB recommends 101°F-103°F, some vets are okay at 100°F) before an emergency happens so you have a baseline to compare against.
Abdominal palpation is less reliable for liver lobe torsion than for GI bloat. Unlike bloat, where the stomach distension is often palpable, the liver sits differently in the body. You may not feel anything abnormal on the outside even when something is seriously wrong internally. Do not use the absence of abdominal hardness as reassurance.
The Rabbit Grimace Scale is another useful home assessment tool Dr. Nguyen referenced (and one we go over during Wellness Rally). Orbital tightening, flattened cheeks, a V-shaped or flaring nose, whiskers grouped forward, and ears pinned back are all indicators of pain. A rabbit in severe pain will often grind their teeth at the same time. You can search "rabbit grimace scale" to familiarize yourself with what each level looks like. It is a peer-reviewed assessment tool and one of the most useful things a rabbit parent can learn.
What Happens at the Vet: Stabilization First
Dr. Nguyen was clear that stabilization comes before diagnostics in a critical rabbit. By the time a rabbit presents with low body temperature and shock-level deterioration, an experienced emergency vet will begin stabilization, IV fluids, pain medication, blood sugar supplementation, before completing a full diagnostic workup.
The blood vessels in a severely shocked rabbit can be the size of a hair. Getting an IV catheter placed is often the first significant challenge, typically done in the ear veins or front limbs. Blood sugar is checked immediately because these rabbits often crash their glucose levels and require supplementation directly into the bloodstream. IV pain medications provide immediate comfort while stabilization continues.
Meanwhile, the vet is monitoring and reassessing continuously, body temperature, overall parameters, to confirm that stabilization attempts are working and that the rabbit is stable enough to move into diagnostics, which itself is stressful for a critically ill animal.
At-home pre-hospital care: If your rabbit is showing signs of distress and you are comfortable administering subcutaneous fluids at home, Dr. Nguyen confirmed this is appropriate and worth doing before transport. The fluids give the body something to work with and can improve vascular access once you arrive. One exception: if your rabbit has a known heart condition, hold off on fluids until you are with a vet. Fluids and heart disease do not always interact well. For kidney concerns, fluids are generally appropriate - kidneys respond well to hydration. Some vets will administer subcutaneous fluids and wait 10-15 minutes for the body to absorb them before attempting IV placement, as it can improve vein quality enough to make catheter placement more successful.
Diagnostics
Once the rabbit is stable enough, the primary diagnostic tool is ultrasound, specifically a point-of-care ultrasound (POCUS).
What a torsion looks like on ultrasound: the affected lobe appears almost pitch black, surrounded by a pocket of fluid. In a normal liver, the lobe shows grayish speckling. The black appearance indicates the lobe is diseased, and the fluid around it is almost always blood, which is where the anemia that commonly accompanies liver lobe torsion comes from.
If the abdomen is too distended with gas for ultrasound to penetrate (air is the enemy of ultrasound imaging) diagnosis relies on X-ray and blood work to build a presumptive picture, or a radiologist is called in. A radiologist has specialized tools and techniques that can often see past what a point-of-care ultrasound cannot.
CT scan is the most definitive diagnostic tool but requires full anesthesia, is only available at specialty practices, and the risk-benefit calculation in an already critical rabbit is significant. It is a tool for specific circumstances; not a first-line option in an emergency setting.
Exploratory surgery is sometimes discussed as a diagnostic approach. From a purely diagnostic standpoint, physically seeing the liver is definitive. From a treatment standpoint, the calculus is more complicated - surgery in a critical, unstable rabbit carries its own significant risks, and the decision has to be made carefully based on the rabbit's current stabilization status and what other diagnostics have already revealed.
Blood transfusions are sometimes necessary in severely anemic rabbits. In rabbit medicine, blood is typically available as live transfusions rather than stored units - storage is limited to approximately one to two weeks at most, and availability varies significantly by facility. BCB operates a rabbit blood donor program to help address this gap in Southern California. If you have a healthy rabbit and are interested in enrolling as a donor, reach out to us at info@bunchiaburrow.com.
Treatment: Surgery vs. Medical Management
Surgery (lobectomy) is the recommended approach for critical rabbits where the torsion is confirmed and the rabbit is deteriorating. The damaged lobe is removed; it cannot be untwisted. This is an important point: if the lobe were to untwist spontaneously before surgery, it would release a large amount of toxins into the body, presenting its own serious risk. Whether twisted or spontaneously untwisted, a damaged lobe needs to come out.
Surgery requires prior stabilization, carries inherent risk especially in a critically compromised patient, and involves removing a portion of the liver through an abdominal approach. The more underlying disease is present, pre-existing liver damage, cancer, or other comorbidities, the more complex and risky the surgery becomes.
The outcomes for rabbits that make it through surgery successfully are genuinely good. Rabbits that survive surgery and recover well are often eating within the first 24 hours post-operatively and can be discharged home within 24 hours of surgery. Diet post-surgery returns to normal (hay, pellets, greens) with fruits and high-sugar treats kept minimal to manage blood sugar levels.
Medical management is considered for rabbits who are more stable - those presenting with milder GI symptoms, slight anemia, and POCUS findings that suggest a less critical degree of involvement. Medical management involves hospitalization for 12-24 hours, fluid therapy, pain medication, stasis management, antibiotics depending on blood work and liver appearance, and close monitoring. Some rabbits managed medically do very well. The challenge is that medical management requires vigilant monitoring for deterioration, and the decision between medical and surgical management depends entirely on the rabbit's clinical status at presentation.
Entyce (capromorelin),an appetite stimulant, was discussed as an effective tool in post-torsion recovery and GI stasis management. Dr. Nguyen noted that based on current research, Entyce performs better than mirtazapine (transdermal) for rabbits. It is relatively new in rabbit medicine but client reports of improvement are consistent - some rabbits begin eating within one to two hours of administration. It is worth asking your vet about specifically if your rabbit is recovering from a torsion or struggling with appetite during a stasis episode.
Recurrence
Liver lobe torsion can recur, though recurrence after surgical removal of the affected lobe is rare. If the caudate lobe has been removed surgically and the rabbit experiences torsion again, it is most likely a different lobe - the left lobe being the next most common, though still significantly rarer than caudate lobe involvement.
In cases where the lobe has not been surgically removed, where the rabbit managed medically and the lobe stabilized. recurrence of torsion in that same lobe is possible. The liver is resilient and can compensate for significant damage, which is part of why medical management can work in less critical cases. But it is also why close monitoring and follow-up are essential after any liver lobe torsion event, regardless of how it was managed.
Lop breeds, particularly mini lops, may have elevated risk, possibly related to their anatomy, though the research on breed predisposition in rabbit liver lobe torsion is still limited.
The Most Important Thing
Liver lobe torsion is not something you can prevent with certainty or diagnose at home. What you can do is know your rabbit's baseline, their normal temperature, their normal mucous membrane color, their normal activity and appetite, so that when something is wrong, you recognize it immediately and go.
The window between early signs and critical deterioration can be short. Early presentation gives the vet more options and the rabbit a better chance.
If your rabbit is suddenly not themselves and you cannot identify a clear benign reason, go to your rabbit-savvy exotic or emergency vet. Do not wait to see if it resolves.
See our LA + OC Exotic Vet Directory → for emergency-capable exotic vets in Southern California, including VEG locations throughout LA and Orange County.
Source:
Dr. Jeremy Nguyen, DVM — Vet Set Talk, Bun Chia Burrow, July 26, 2026. Medical Director, Emergency + Exotic Veterinarian, Veterinary Emergency Group (VEG), Costa Mesa, CA.