Abstract Background: Intestinal obstruction is a common surgical emergency associated with significant morbidity and mortality. Imaging plays a critical role in early diagnosis, localization, and identification of the cause and complications. Aim: To evaluate and compare the diagnostic efficacy of ultrasonography (USG) and contrast enhanced computed tomography (CECT) in clinically suspected intestinal obstruction, with correlation to intraoperative findings. Materials and Methods: A prospective observational study was conducted on 100 patients with clinically suspected intestinal obstruction over a period of 18 months. All patients underwent ultrasonography followed by contrast-enhanced CT of the abdomen. Imaging findings were correlated with intraoperative findings, which served as the gold standard. Diagnostic performance parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The most common age group affected was 16–30 years (33%), with male predominance (64%). CECT detected intestinal obstruction in 99% of cases, predominantly small bowel obstruction (94%), whereas USG detected obstruction in 54% of cases. Distal small bowel was the most common site of obstruction (61%). CECT demonstrated significantly higher sensitivity, specificity, and overall diagnostic accuracy compared to ultrasonography in identifying the presence, level, and cause of obstruction. Conclusion: CECT is superior to ultrasonography in the evaluation of intestinal obstruction and should be considered the imaging modality of choice in clinically suspected cases.