Background and objectives: Intestinal obstruction remains one of the commonest causes of acute abdomen worldwide. The underlying causes vary from country to country and change within the same country. Our study is to determine the pattern of intestinal obstruction in Hajjah governorate and evaluate surgical management.
 
Patients and methods: All patients operated on for acute intestinal obstruction in the Department of Surgery in Saudi hospital at Hajjah governorate in Yemen between July 2012 and September 2014, were included in this study. Patients` demographics, medical history, clinical examination, para-clinical investigations, operative finding, type of procedure and postoperative complications were prospectively collected and analyzed.
 
Results:  The total number enrolled in this study was 164 patients, 101 men and 63 women with age range from 1 day to 80 years old. 
Strangulated/obstructed external hernias were the most common cause of intestinal obstruction (48 patients, 29.2 %) followed by intra-peritoneal adhesions and bands (39 patients, 23.7%). Intussusception was found in 20 patients (12.1%). Intestinal volvulus and malignancy of the colon were found in 17 and 15 patients respectively (10.3% and 9.1%). Other rare causes such as ascaris (1.8%), postoperative intraperitoneal tube drain (0.6%), intestinal tuberculosis (1.8%) and foreign body in the rectum (0.6%) were found too. 
Adhesiolysis and intestinal resection were the commonest operative procedures. Postoperative complications were found in 44 patients (26.8%). Mortality was recorded in 15 patients (9.1%).
 
Conclusion: Strangulated/obstructed external hernias were the most common cause of acute intestinal obstruction followed by adhesive causes, intussusception, intestinal volvulus and colonic tumors. Adhesiolysis and resection of gangrenous intestine were the most perforated procedure.
 Our postoperative complications and mortality remain accepted and lower than others.