Small gut obstruction is the most common surgical disorder of the small intestine and it refers to any form of impedance to the normal passage of bowel contents: 1. Functional obstruction (a dynamic) i.e. paralysis of the intestinal transit. 2. Mechanical obstruction (dynamic) i.e. physical blockage. It is of two types: (i) simple obstruction occludes the lumen only and (ii) Strangulation obstruction impairs the blood supply and leads to the gangrene of the bowel. Obstruction may be partial or complete. Etiologically, the site of disease causing mechanical obstruction may be outside the wall—extrinsic—adhesions: hernia, volvulus, intussusception, inflammatory masses, neoplastic masses, congenital bands. Within the lumen—luminal: Gall stones, foreign bodies, bezoars, parasites. Within the wall—intrinsic: Crohn’s disease, carcinoma, tuberculosis, congenital atresia. Causes of functional intestinal obstruction may be grouped into: Metabolic, electrolyte imbalance, Hypothermia, diabetic ketoacidosis, uremia, peritoneal sepsis, peritonitis, pelvic and inter-loop abscesses, reflex inhibition of motor activity, postoperative paralytic ileus, spinal injury, retroperitoneal haemorrhage, head injury, chest infection, drug induced, tricyclic antidepressants, general anesthetics, mesenteric vascular diseases. Symptoms depend upon the level of intestinal obstruction. Proxi­mal/high obstruction presents mainly with profuse vomiting, variable abdominal pain and rarely with distension. Middle obs­truc­tion presents with moderate vomiting, moderate distension, and intermittent pain with free intervals. Low or distal small bowel obstruction presents with late feculent vomiting, marked distension with pain of variable degree. Plain film Radiographs: 50–66% (sensitivity). Plain film reveals distended gas filled proximal bowel loops with air fluid levels and absence of gas beyond obstruction. More than 3 distended small bowel loops with > 3 cm size with gas fluid level. Disparity in size between obstructed loops and contiguous small bowel loops of normal caliber beyond site of obstruction. Now considered as technique of choice for the investigation of suspected intestinal obstruction and confirming the presence of small intestinal obstruction. CT accurately diagnoses the obstruction, determines the cause and location and even suggests associated bowel ischemia and strangulation before surgery. No need of oral contrast, as the inherent contrast of fluid and gas filled intestinal loops provide the necessary information. CT diagnosis of bowel obstruction can be made by the presence of dilated proximal bowel more than 2.5 cm and a collapsed distal bowel with diameter of 1.0 cm or less with intervening identifiable focal transitional zone. Partial small bowel obstruction may be treated conservatively initially and if there is no improvement after 48 hours or if earlier deterioration in general conditions occurs or the symptom progresses the conservative regime is abandoned. Complete obstruction of small intestine is treated by operation after a period of careful preparation. The general aims when operating on patients with intestinal obstruction are: (i) decompress obstructed bowel, (ii) correct the cause, (iii) maintain intestinal continuity, and (iv) avoid iatrogenic damage to distended viable bowel.