The following points may be helpful to distinguish between sigmoid volvulus and cecal volvulus on plain radiographs.
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 gas-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 gas-fluid level may be seen 1