A 64-year-old woman, gravida 2, para 2, underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy due to symptomatic uterine fibroids. Intraoperative findings were notable for significant adhesive disease involving loops of small bowel to the anterior abdominal wall from a prior ventral hernia repair with mesh. Adhesiolysis took 1 hour. Postoperative days 1 and 2 were uneventful except for minimal oral intake with progressive abdominal distension. On the morning of postoperative day 3, she complained of nausea and abdominal distension. She reported worsening dyspepsia, minimal appetite, and no flatus or bowel movement since surgery. Her pain remained well controlled on oral pain medication. She was ambulating without difficulty.