Background: Bowel ischemia is the key time-critical complication in adhesive small bowel obstruction (ASBO). This research is to compared Bouassida score and neutrophil-to-lymphocyte ratio (NLR) for assessing ischemia.

Methods: Adult ASBO patients undergoing surgery at a tertiary center were analyzed. NLR was calculated from preoperative blood counts; Bouassida categories were assigned using clinical, laboratory, and CT variables. Ischemia was defined intraoperatively and/or by histopathology.

Results: Ischemia was associated with prolonged pain, fever, leukocytosis, decreased bowel-wall enhancement, and segmental mesenteric fluid on CT (all p<0.001). No ischemia was observed in the Bouassida low-risk category, while the high-risk category aligned with ischemia (p<0.001). Mean NLR was higher in ischemia than non-ischemia (12.0±4.3 vs 5.6±2.1; p<0.001).