Sigmoid volvulus versus caecal volvulus

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 proximal large bowel, therefore the ascending, transverse and descending colon may be dilated
  • few air-fluid levels may be seen
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