• 63.4% of patients with adhesive small bowel obstruction (ASBO) had successful conservative treatment.
• Key factors predicting treatment failure include: vomiting (aOR 0.476), abdominal distension (aOR 0.301), and guarding/rebound tenderness (aOR 0.354).
• Generalized tenderness was positively associated with success (aOR 1.903).

Surgeons can use these clinical symptoms and imaging findings to identify patients who may need timely surgical intervention, improving overall outcomes.