Background and aims: Small bowel obstruction can be managed both conservatively and surgically based on the clinical symptoms and signs in the patient. The aim of this study was to observe the patients with small bowel obstruction and compare their symptoms with type of management. Materials and methods: This was a prospective observational study conducted at surgical tertiary care centres in Chennai, Tamilnadu, India. Patients with symptoms of small bowel obstruction were observed and analyzed between September 2012 and November 2013. Purposive sampling technique was employed to select patients with age between 18 and 75 years. Data entry and analysis was done using SPSS version 17. Results: Of the 100 patients observed, small bowel obstruction was seen more in 26–45 age group (55%), more in females (54%), abdominal pain was the most common symptom (85%), appendectomy was the commonest preceding surgery (33%), dilated bowel loops was the common radiographic finding (73%) and most patients were managed conservatively (86.9 %). Conclusion: Small bowel obstruction is better managed conservatively. As the prediction of patients who will require surgery is difficult, a scoring system is proposed, where patients with a score of more than 4 will need surgical intervention.