Background: Adhesive small bowel obstruction (ASBO) is a frequent surgical emergency and represents the leading cause of small bowel obstruction worldwide. Intestinal ischemia is a life-threatening complication of ASBO, and delayed diagnosis significantly increases morbidity and mortality. Reliable and objective predictors of intestinal ischemia are therefore crucial for timely surgical decision-making.

Objective: This study aimed to evaluate the role of the Bouassida score as a predictor of intestinal ischemia in patients with ASBO treated at H. Adam Malik General Hospital, Medan.

Methods: An observational analytic study with a cross-sectional design was conducted using medical record data of ASBO patients admitted between June and August 2024. The Bouassida score was calculated based on six clinical and radiological variables. Intestinal ischemia was confirmed intraoperatively or radiologically. Statistical analysis was performed using Fisher’s exact test, with a significance level set at p < 0.05.

Results: A total of 24 patients were included, of whom 11 (45.8%) developed intestinal ischemia. All patients with Bouassida scores >16 experienced intestinal ischemia, while none with scores ≤6 developed ischemia. A statistically significant association was found between Bouassida score categories and intestinal ischemia (p < 0.001).

Conclusion: The Bouassida score is a strong and reliable predictor of intestinal ischemia in patients with ASBO and may serve as a valuable clinical tool to guide early surgical intervention.