Large bowel obstruction (LBO) is a serious and costly medical condition, indicating often emergency surgery. The main clinical issue is to determine whether the obstruction affects the small bowel or the colon since the causes and treatments are different. Delay in operative intervention may lead to an unnecessary bowel resection, increased risk of perforation, and overall worsening of patient morbidity and mortality. With the advent of colonic endoluminal stent, the treatment of distal colonic obstruction should be individually tailored to each patient. This article discussed LBO and emphasized the importance of history taking, examination, and basic imaging in the early diagnosis of its cause, thus facilitating appropriate management.