To improve the results of treatment of acute adhesive small bowel obstruction there was formulated and developed a new method for the diagnosis of a strangulation form of obstruction, based on the prognostic evaluation of routine clinical, laboratory and instrumental data. Retrospective analysis and estimation of the results of treatment of 274 patients with acute adhesive small bowel obstruction were performed. As a result of the comparative analysis of the two groups of patients — with obstructive (group 1 — 208 patients (75.9 %)) and strangulation (group 2 — 66 patients (24.1 %)) forms of obstruction there were identified 10 criteria and developed a predictive system which allowed to differentiate the form of the disease. With heterogeneous sequential analysis for each of the resulting diagnostic criteria there were calculated ratios and assigned points according to its differential diagnostic significance. As a result, there were identified three prognostic groups of patients — with high, medium and low risk of strangulation. System efficiency was 89.8 %.