Abstract Background: Multi detector computed tomography (MD-CT) has become a mainstay in diagnosing bowel obstruction. Because the management of obstruction has dramatically changed with a decrease in the proportion of patients who need surgery, a precise CT evaluation is now both the gold standard and the common approach in patients with suspected bowel obstruction. Results: A total of 51 patients were eligible for inclusion in our study, all patients were admitted to emergency Depart-ment of Kasr Al-Ainy Teaching Hospital with clinical and radiological features of acute small bowel obstruction(ASBO). MDCT showed bowel obstruction in 40 (78.4%) patients, small bowel obstruction in 35 (68.6%) patients and large bowel obstruction in 5 (9.8%) patients, follow-up CT scan showed that contrast reached the large bowel obstruction was reported in 20 (41.7%) patients. Twelve (23.5%) patients were indicated for surgical intervention, ICU admission was reported in 3 (5.9%) patients, while one case showed leakage on day 1 post exploration. CT showed adhesions in 38 (74.5%) patients with final diagnosis of adhesive intestinal obstruction (IO) in 29 (56.9%) patients. Conclusion: We concluded that MDCT scan is a highly sensitive tool in detection of adhesive intestinal obstruction on the level of small and large bowel. MDCT scan can be used as a very accurate tool in screening for adhesive IO due to higher negative predictive value (100%).