S mall bowel obstruction remains an important cause of morbidity, accounting for up to 15% of surgical admissions for acute nontraumatic abdominal pain. Clinical evidence of complete small-bowel obstruction or complications such as strangulation necessitates emergent surgical management. Traditional medical teaching advocated early operative management of small-bowel obstruction (“Never let the sun rise or set on an obstructed abdomen.”) because clinical features were often unreliable in determining whether complications were present. Radiologic imaging has assumed a paramount role in directing the management of small bowel obstruction, promoted by the widespread availability of MDCT. The key question for a clinician managing a case of suspected small bowel obstruction is how to optimally treat the patient. MDCT accurately answers this question by determining if small bowel obstruction is present, identifying the site and cause of mechanical obstruction, and detecting complications. The sensitivity and specificity of MDCT in this clinical setting is more than 95%, with high accuracy reported in distinguishing small bowel obstruction from adynamic ileus in postoperative patients. Imaging is therefore pivotal in determining whether the patient can be managed conservatively and in guiding the operative approach if surgical management is required.