This case represents a typical presentation of sigmoid volvulus and then pseudo-obstruction.
It also highlights the point that although there was "gas" under the right hemidiaphragm, it was still in the bowel lumen, so there was not a perforation here and this patient did not need to be subjected to CT, surgery, stomas, etc.
Despite a number of decompressions with rigid scopes, flatus tubes, and an attempt at colonoscopy, she was not suitable for any surgical intervention so a rectal catheter was kept in place attached to a collecting bag.