A 72-year-old man presented with a first episode of intestinal obstruction. He had had a prior suprapubic prostatectomy through a low midline incision. Abdominal X-ray showed a large dilated loop of colon extending from left lower quadrant to right upper quadrant. A diagnosis of sigmoid volvulus was made based on the orientation of the loop (see cecal bascule). The volvulus was hydrostatically reduced with gastrografin enema.