A 75 year old lady presents with crampy lower abdominal pain and progressive distension since 2 days. She had the onset of vomiting a few hours before admission. She has had no bowel movement or flatus for 2 days. On exam she appeared acutely ill with P 96, BP 130/84, T normal, RR 28/min. The abdomen was distended and tender but there were no peritoneal signs.