An x-ray (with or without contrast) may be helpful in the diagnosis of volvulus. Findings on an x-ray suggestive of sigmoid, cecal and ileal volvulus include: U-shaped, distended segment of colon seen as an ahaustral collection of gas volvulus. Findings on an x-ray suggestive of gastric volvulus includes a single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level. It is important to rule out pneumoperitoneum before carrying out a barium enema.

• A plain x-ray without contrast may be helpful in the diagnosis of volvulus. Findings on an x-ray suggestive of volvulus include:^[1][2][3]
  • Sigmoid/cecal/ileal volvulus: U-shaped, distended segment of colon seen as an ahaustral collection of gas
  • Gastric volvulus: Single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level
• The following result of plain x-ray with contrast barium enema is indicative of volvulus:
  • Bird beak appearance or twisted tapering of afferent and efferent colonic segments
• Plain x-ray with contrast barium enema can be utilized in the following circumstances:
  • Therapeutically in an attempt to reduce volvulus
  • If plain x-ray is not diagnostic and CT is not available
• Plain x-ray with contrast barium enema is contraindicated in:
  • Peritonitis
  • Pneumoperitoneum
  • Necrotic bowel

It is important to rule out pneumoperitoneum, this means that a perforation in the bowel has occurred and that air is in the peritoneum. It is a surgical emergency.