Recently, we attended a 46-year-old man in our hospital, with a history of Down's syndrome and severe mental retardation, who came to the emergency department of our hospital presenting with diffuse abdominal pain and progressive abdominal distension of 24 hours' duration. He presented a history of constipation and absence of bowel movements in the last 2 days. As a background of interest, the patient had presented, 13 years earlier, with a gastric volvulus that was operated on urgently, and a surgical gastropexy was performed. During the operation, a dolichocolon was observed, with absence of fixation ligaments, but no procedure was performed on it. In the current physical examination, the only findings were abdominal distension and tympanism, accompanied by diffuse abdominal pain. Rectal examination failed to demonstrate stool in rectal ampulla. Haemogram and biochemistry were normal. Plain abdominal X-ray showed massive dilatation of the proximal colon. This distension could also be seen on computed tomography (CT). Subsequent barium enema demonstrated the typical "bird's beak" image. Although with difficulty, the barium passed into the dilated segment of the splenic angle. A therapeutic colonoscopy was performed, which succeeded in untwisting the colonic segment. The patient passed a large amount of stool and gas, remained asymptomatic after 24-48 hours, and was discharged from the hospital and referred to the surgical department. Two days later, his symptoms reappeared and he was diagnosed with recurrence of volvulus of the splenic flexure of the colon. The colonoscopy was repeated and the urgent process was again resolved. The patient underwent scheduled surgery and resection of the redundant segment of the colon was performed. The postoperative period was uneventful.