The following points may be helpful to distinguish between sigmoid volvulus and cecal volvulus on plain film.
Sigmoid volvulus
- arises in the pelvis (left lower quadrant)
- extends towards the right upper quadrant
- ahaustral in appearance
- sigmoid volvulus causes obstruction of the distal large bowel; therefore, the ascending, transverse and descending colon may be dilated
- few air-fluid levels may be seen 1
Cecal volvulus
- arises in the right lower quadrant
- extends towards the epigastrium or left upper quadrant
- colonic haustral pattern is maintained
- distal colon is usually collapsed and the small bowel is distended
- one air-fluid level may be seen 1
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