consider conservative management
Surgical consult
Bowel rest/decompression [NPO, NG tube, rectal tube]
Rehydration/Electrolyte repletion
Pain management [No opioids]
Management of comorbid conditions
Neostigmine then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases
Neostigmine for cecal diameter >10cm
2-2.5mg neostigmine IV over 5min
Exclude patient with HR<60, low SBP, peritoneal signs
Neostigmine for cecal diameter >10cm
2-2.5mg neostigmine IV over 5min
Exclude patient with HR<60, low SBP, peritoneal signs
Emergent surgical consult
Antibiotics
Ogilvie's syndrome
Malignancy 
Dressler's syndrome
Diverticular disease
Fitz-Hugh-Curtis syndrome
Compression from metastatic disease
Mallory-Weiss tear
Impaction