Adhesive intestinal obstruction, which was a rare post-operative complication in the early advent of modern surgery, is now the most common from of intestinal obstruction. Nevertheless considerable controversy still exists concerning the ideal therapy, the indications for and the timing of surgery. The main problem is how to avoid strangulation. In an attempt to define an optimal strategy for managing intestinal obstruction secondary to adhesions, we recommended a conservative trial of up to 48hs for spontaneous resolution. Abdominal ultrasonography and abdominal CT scanning proved to be useful for the early recognition of strangulation and consequently , for reducing the number of both delayed operations for strangulation and unnecessary operations for simple obstruction.