Background: Adhesive small bowel obstruction (ASBO) is small bowel obstruction resulting from adhesions that follow previous abdominal and/or pelvic surgeries. It is one of the most common puzzle facing general surgeons worldwide including Ethiopians. It is among the most common reasons for admission to a surgical service. The management of adhesive small bowel obstruction (ASBO) has evolved from “the sun should not rise and set on a small bowel obstruction”, implying mandatory immediate surgical exploration to selective non-operative management. Objectives: To assess the magnitude, management & outcome of postoperative adhesive small bowel obstruction at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). Methods : Facility based descriptive cross sectional study was conducted by reviewing a 3 year patient card registry data (from July 1 /2017 – June 30/2020) on September 2020 at Felege Hiwot Comprehensive Specialized Hospital. Simple random sampling method was used and data was collected using data collecting checklists. A total of 255 patients were included in the study. The data was processed & analyzed using SPSS program version 20 & the analyzed data was described using frequency tables, graphs and figures accordingly. Results: The findings of this study showed that the proportion of ASBO in FHCSH was 40% with 95% CI (34.1, 45.9). Sixteen patients (15.7%) were found to have gangrenous bowel. From one hundred two patients admitted with ASBO, fifty-three patients (52%) responded for nonoperative management. Seven patients (6.9%) failed to respond with nonoperative treatment & underwent delayed operation. The majority of patients (98%) were discharged with improvement & in hospital mortality rate was 2%. Conclusion: ASBO is the leading cause of small bowel obstruction at FHCSH, Bahir Dar, Ethiopia. Conservative management is effective in at least half of patients with ASBO. Key words: adhesive small bowel obstruction, magnitude.