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An 80-year-old male with a history of atrial fibril-lation on apixaban, hypertension, hyperlipidemia, and bladder cancer underwent robotic cystectomy with extracorporeal ileal conduit 8 years prior. His final pathology showed multifocal carcinoma in situ (pTisN0Mx). Although he had no recurrence of disease, his course was complicated by recurrent urinary tract infections, some resulting in urosepsis, for which he followed with Infectious Diseases and was managed with chronic antibiotic prophylaxis. He had a postoperative Lasix renal scan without evidence of obstruction. The patient reported recurrent intermittent abdominal pain over a 2-month period; however, he developed abdominal pain, nausea, and vomiting with feculent emesis over the week prior to presentation. He reported that his abdominal pain acutely worsened and he was not passing gas within the 24 hours prior to emergency department presentation …