The diagnosis of bowel obstruction and the determination of the necessity for surgical intervention can produce significant challenges for both the initial evaluator and the surgeon. A delay in definitive surgical treatment can lead to necrosis, perforation, sepsis, and potentially death. However, surgical consultation for every patient with emesis, constipation, or bowel dilation on imaging can lead to unnecessary costs, and an overutilization of resources that can cause delays in care to other patients. This chapter aims to present evidence-based guidelines to help the initial evaluator of a patient with symptoms or signs of bowel obstruction to determine the necessity for surgical consultation.