A 75-year-old male presented with abdominal pain and abdominal distension to our surgical outpatient clinic in Mangalore, India. He had similar episodes intermittently for the past 8–10 years which had increased in frequency since the past 1 year. These recurrent episodes were managed conservatively until the current admission. The patient gave history of worsening of pain along with constipation for the last 7 days, which prompted him to seek medical help for the first time. He had no history of vomiting, loss of weight or appetite. On further enquiry about his previous episodes, he explained that he would have similar symptoms of abdominal pain, distension and constipation which would last for 2–3 days, for which he would self-prescribe acetaminophen and bulk laxatives, which would resolve his symptoms. He denied long term use of NSAIDs or any other kind of medications. He gave no history of alternating constipation and diarrhea, bleeding per rectum or tenesmus. He had no history suggestive of stigmata associated with tuberculosis. His past medical or surgical history was not of significance. On general examination, the patient was tachycardic (109/min), tachypneic (22/min) with a blood pressure of 108/72 mmHg. On inspection, the abdomen was distended with no surgical scars, sinuses, peristalsis or dilated veins noted. The hernial orifices were free. On palpation, there was no local rise of temperature, however his abdomen was mildly tender. There were no obvious masses that were felt. On percussion, resonant note was heard all over. He had hyperactive bowel sounds on auscultation. There were no signs of liver cell failure or clinical signs of dehydration. Absence of faeces with a roomy rectum was noted on digital rectal examination. Respiratory and Cardiovascular system examinations were within normal limits. There were no abnormalities noted on groin and external genital examination. At the end of history and clinical assessment, we had reached a probable diagnosis of Intestinal Obstruction with cause to be determined.