Treatment of acute obstruction of the small intestine continues to be controversial. Some authorities recommend early surgical intervention and others prefer nonoperative intestinal intubation as the basis for therapy. The latter approach of necessity is based on the premise that the clinical recognition of the presence of strangulation is precise, since this type of obstruction is uniformly fatal without operation. The proponents of primary nonoperative therapy of intestinal obstruction1-4 indicate that careful and frequent evaluation of the patient, continually observing for tenderness, rigidity, hypoperistalsis, the presence of a mass, fever, tachycardia, and leukocytosis will result in the correct diagnosis of strangulation in the vast majority of cases. On the other hand, advocates of a basically surgical approach to the treatment of obstruction of the small intestine dispute this contention.5-10 The present study has been carried out to ascertain the reliability of various criteria used to aid in the