An 80-year-old man presented with acute onset severe abdominal pain, distention, and constipation. Imaging showed signs of sigmoid volvulus including the coffee bean sign and loss of haustral markings. Treatment involves decompression, IV fluids, analgesics, and surgical consultation for potential endoscopic reduction or sigmoid resection to treat the volvulus and prevent recurrence in this elderly patient with a history of chronic constipation.