For veterinary professionals
October 2026
"Not eating, not pooping" is one of the most common complaints on any exotics schedule. Most of those rabbits have uncomplicated rabbit gastrointestinal syndrome (RGIS) and go home with supportive care. A few are surgical emergencies wearing the same disguise, and some of them don't have hours to spare. These are things we encounter in practice, and here are some options I've found useful for sorting them out.
Cases should not be left in the waiting room until their scheduled appointment without triage. A technician or veterinarian should lay eyes and hands on every anorectic rabbit as it comes through the door.
The rabbit I'm comfortable treating as an outpatient is bright and responsive, with a doughy abdomen, slightly small stools and perhaps some cecal gas. The rabbit that worries me is depressed, painful on palpation, bradycardic or hypothermic (below 100°F), hunched or laterally recumbent, or has a large, firm stomach or a firm mass cranial to it. That second rabbit needs a minimum database and a decision today. Either way, take a real diet history.
With a proximal duodenal obstruction, a rabbit can go from quiet to laterally recumbent within hours. The classic patient is bradycardic, hypothermic and hypotensive, likely from a distended stomach compressing venous return. Palpate gently, because gastric rupture is possible.
On radiographs, the pattern to look for is a large, fluid-filled stomach with a gas cap touching the ventral abdominal wall, often with two populations of bowel. A compacted pellet of ingested hair is the usual culprit. The encouraging part is that most cases resolve medically with gastric decompression and aggressive IV fluids.
Because caudal venous return is impaired until the stomach is decompressed, place a cephalic catheter rather than a hindlimb catheter.
Decompress under heavy sedation or general anesthesia. If the rabbit isn't anesthetized, use a tube guard. I strongly recommend this after operating on a lightly sedated rabbit that had bitten off and swallowed an unguarded tube. A syringe case or funnel works. I use the largest red rubber catheter the patient will accept and add side holes with a 3 mm skin punch, but only over the first 1 to 3 cm. Too many holes can cause aspiration during placement because intragastric pressure is so high.
Older literature painted a grim surgical picture, but more recent data are considerably more encouraging, particularly in young rabbits. When feasible, milk the obstruction into the cecum, or back to the stomach for a routine gastrotomy if it's proximal.
Liver lobe torsion (LLT) is likely more common than it's given credit for. Typical patients are young adult mini or Holland lops with a cranial abdominal mass. Most have increased ALT and/or ALP, but two of my 27 cases had normal liver values, so a normal panel doesn't rule it out. Ultrasound is usually the key test, yet I've had an inconclusive scan delay a diagnosis.
Classically the caudate lobe is cited, but I've also seen quadrate, left lateral, left medial and right lateral lobe torsions. Unless the affected lobe is confirmed, I use a midline approach. Double ligation, hemoclips or a vessel-sealing device are all options. Medical management can carry a rabbit through the short term, but surgery has been associated with longer long-term survival.
Appendicitis is uncommon. Clues include hyperthermia, hypocalcemia, hypoglycemia, anemia and a painful abdomen. Abdominal ultrasound or CT confirms it, and treatment is surgical.
GDV has only recently been described in rabbits. Every reported case has had elevated ALT, with variable ALP and bilirubin, consistent with common bile duct compression. In a rabbit with acute cranial abdominal pain and that biochemical pattern, LLT and GDV belong at the top of the list. Radiographs have not reliably shown it. On ultrasound, a spleen displaced to the left cranial abdomen supported the diagnosis in my published case, and CT is confirmatory when available. Treatment is derotation plus incisional gastropexy.
Explore the whole abdomen. I've had GDV and LLT in the same rabbit, and even when one lesion appears to explain the clinical signs, additional pathology may be present.
Triage on arrival, use the cephalic vein and a tube guard, and don't let a normal liver panel or one equivocal ultrasound talk you out of LLT.
If you have a rabbit with a firm cranial abdomen, a puzzling liver panel or a decompression you'd like to talk through, reach out to Nashville's rabbit specialist. Dr. Logan Kopp, DABVP (Exotic Companion Mammal Practice), sees referrals and surgical cases at Priest Lake Veterinary Hospital, (615) 361-4646. Please call before sending an unstable patient. See Referring a Rabbit with Suspected GI Stasis for stasis referrals, and the referring veterinarians page for general details.
This content is for educational purposes for veterinary professionals. It doesn't establish a VCPR or replace clinical judgment for an individual patient. Drug use and doses should be checked against current references and adjusted for each case.