ABSTRACT Background: Adhesive intestinal obstruction is a frequent consequence following abdominal surgery. Bowel obstruction affects about 95% of persons who have abdominal surgery. This study aimed to provide better management and determine best time for surgical intervention for patients with Adhesive Small bowel obstruction (ASBO). Subjects and Methods: This prospective randomized clinical trial was conducted in General Surgery Department, Zagazig University Hospitals. The study included 30 patients of adhesive small bowel obstruction. Patients in this study were divided randomly into two groups: Group (A) included 15 patients underwent non operative (conservative) management and Group (B) included 15 patients underwent operative management. Results: Our results showed that 8 (53%) cases of patients in the conservative group underwent surgical intervention due to failure of conservative management and 13(86.6%) of patients in the operative group underwent early exploratory laparotomy. Open appendectomy was the commonest previous operation in all study group followed by Cesarean section. Recurrence of SBO was 7 (46.6%) in the conservative group in comparison 2(13.3%) in the operative group with P value 0.0042, recurrence of SBO was significantly higher in the conservative group. Conclusion: Surgery performed early during 24 h of admission in patients of ASBO has shown to be highly effective, with a lower rate of recurrence.