A 67 year old male presents to the ER with a 2 day history of nausea and vomiting, abdominal bloating and a decreased frequency of bowel movements. He has no prior history of operations. He relates a history of two prior similar episodes which have resolved spontaneously at home over the last 3 months. Physical exam: T 37.8 degrees C, HR 98, RR 20, BP 148/78. The abdomen is distended and not tender. There are no scars or hernias on exam.