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Small bowel obstruction is a common and dangerous surgical emergency which is associated with high morbidity and mortality if not managed appropriately and timely. To determine the causes and management outcome of small bowel obstruction in Nekemte Referral Hospital, Nekemte, Ethiopia. Institution-based retrospective cross-sectional study design was used. Three-year data (from January 1, 2014, to December 30, 2016) were collected from July 1 to August 30, 2017. Data were collected from medical records and checked for any inconsistency,