Spirulina-associated hepatotoxicity

of the population have a clinically silent abnormality of intestinal rotation. Discovery of anomalous intestinal rotation in an asymptomatic adult does not warrant any surgical intervention (7). However, both patient and physician should be aware of the abnormality so that abdominal symptoms are interpreted correctly and managed properly. If our patient’s intestinal rotation abnormality were known, cecal volvulus might have been suspected earlier. Although abdominal discomfort after colonoscopy is common, pain that is severe or increasing several hours after the procedure should not be dismissed. Complications such as perforation, ileus, splenic injury, hematoma, and incarceration of an inguinal hernia should be considered. Although rare, cecal volvulus should also be considered, especially if the patient is known to have an intestinal rotation abnormality or other risk factors for cecal volvulus.