A 61 year old male presents to the emergency room with a 3 day history of crampy mid-abdominal pain, nausea, and bilious emesis three times and no bowel movement in 24 hours. The patient reports one small episode of flatus today. On exam, heart rate is 112, BP is 120/60, respiratory rate is 20, and temperature is 37.8. Abdominal exam reveals a well healed midline scar, distended abdomen with bowel sounds present and mild tenderness without peritoneal signs.