Background : large-bowel obstruction (LBO) is an abdominal emergency, with high morbidity and mortality rates if left untreated While LBO may develop over a protracted period of time, the clinical presentation is often acute and includes abdominal pain, constipation or obstipation, and abdominal distension . The marked distension of colon proximal to the level of obstruction leads to mucosal edema, bowel ischemia, and, if not treated, bowel infarction and perforation. In general, we have 3 types of large bowel volvulus. among this sigmoid volvulus is the most common type. In Ethiopia there is no published data about imaging pattern of large bowl volvulus as well as in Africa Objective To determine and correlate different imaging pattern of large bowel volvulus on those who have intraoperatively confirmed LBV presented with acute abdomen between 2019-2021 G.C at TGSH and FHR Methods: Hospital based cross-sectional study was carried out on those who had intraoperatively confirmed LBV in Tibebe-Ghion and Felge Hiwot specialized hospital, Bahir Dar Ethiopia. Data collection sheets was used to record the demographic information, the clinical information, Abdominal x-ray and surgical findings. Those confirmed cases had erect or plain abdominal x-ray that have been evaluated and reported by senior radiologist and radiology residents .Data was entered using EpiData software and sent for analysis using SPSS window version 25. The study was conducted from September 2021 to November 2021G.C. Results : we analyzed 70 patients among this 67 patients are sigmoid volvulus, 2 patient cecal volvulus and 1 patient Transverse volvulus .the most common types of large bowel volvulus is sigmoid volvulus (95.8% ) followed by cecal volvulus ( 2.8%) and transverse volvulus (1.4 %) . It is most common in old men and rural area .Diagnostic sensitivity of plain abdominal radiography for Sigmoid volvulus is (98.6% ) , 100 % (for cecal volvulus ) and Null for transverse volvulus The main radiography findings for sigmoid volvulus is empty rectum with dilated and inverted u shape Sigmoid colon with extension of the apex toward right upper quadrant (83 %) and dilated and inverted u shape Sigmoid colon with extension of the apex toward left upper quadrant (17 %) The main radiography findings for cecal volvulus is dilated cecum with absent rectal gas shadow , single air fluid level(in both patients ) and extension of the tip of dilated loops toward left upper quadrant (50 %) .Transverse volvulus has nonspecific imaging finding mostly they have centrally located dilated large bowel loops with absent rectal gas shadow without air fluid level and that is difficult to diagnose only with abdominal x-ray finding .in our study there is only one transverse volvulus patient which is missed with abdominal X-ray . Plain abdominal X-ray has poor sensitivity to diagnose bowel loops infarction in large bowel volvulus patients ( in our study 45 % patients had gangrenous bowel loops but none of them detected with plain abdominal radiography imaging ) Conclusions: Plain abdominal radiography has high sensitivity to diagnosis LBV (95 %) , but has poor diagnosis potential to diagnose transverse volvulus. It also has poor sensitivity to diagnose bowel wall infarction without considering reader physicians’ individual different skill and knowledge .Clinical sign and symptoms of LBO is helpful to diagnose LBV specially on those patients who had fever with other large bowel obstruction sign and symptoms had high risk for bowel loops infarction (45%). when there is clinical and plain abdominal radiography dilemma of Large bowel obstruction ,it is better to do further investigate patients with barium enema and abdominal CT scan Key words: large bowel loop, volvulus, Abdominal radiography , sigmoid colon , transverse colon , cecum