Background: Early prediction of intestinal ischaemia is a significant clinical problem in non-strangulated adhesive small bowel obstruction (ASBO) cases. Numerous biomarkers have been suggested as possible predictors, such as D-dimer, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). Furthermore, computed tomography (CT) is essential for detecting ischaemia. Patients and methods: This prospective observational study was conducted at Al-Ahrar Teaching Hospital on 130 patients diagnosed with adhesive small bowel obstruction, were divided into: those with ischaemia and those without, serving as the control group. Results: Ischaemia group had significantly higher D-dimer levels, NLR, PLR, WBC count, and lactate levels, while haemoglobin and platelet count were significantly lower in the ischaemia group.  CT imaging emerged as a critical diagnostic tool, with bowel wall enhancement was the most significant CT predictor. The study also found D-dimer as the most reliable biomarker, with an AUC of 0.836, sensitivity of 87.1%, and specificity of 83.1% at a cutoff of 1.5 mg/L. Conclusion: In order to improve the early detection and treatment of intestinal ischaemia in ASBO patients, our results highlight the significance of a multimodal diagnostic approach that combines laboratory markers (such as D-dimer, NLR, and lactate) with CT imaging features (such as gut wall enhancement and mesenteric haziness). These revelations give physicians important direction for improving diagnostic methods and lowering death rate.