Background: Intestinal obstruction is the most common surgical emergency worldwide. Intestinal obstruction continues to remain a challenge to surgeons despite advances in the field of medicine, surgical technique and accounts for high mortality ranges from 3% to 30% all over the world. Objective: The study aimed to assess management outcome and its associated factors among surgically treated intestinal obstruction cases, at Dilla University Referral Hospital 2020 GC. Method: Hospital-based cross-sectional study was conducted on all cases surgically managed for intestinal obstruction, at Dilla University Referral Hospital from November, 1/2016 up to November, 30/2019. Data were collected using a structured questionnaire by trained data collectors. The collected data was checked for its completeness and entered into epidata version 3.1 then exported to SPSS version 26 for cleaning and analysis. The odds ratio along with 95%CI was estimated to measure the strength of the association. Statistical significance was declared at p-value < 0.05. Result: 258 cases were included in this study. From these, 223 (86.4%) cases have favorable surgical management outcomes of intestinal obstruction. Of 35 cases with unfavorable outcome, the most common postoperative complication occurred was surgical site Infection followed by post-operative pneumonia. A total of 4.7% of postoperative deaths were documented as unfavorable surgical management outcomes. Fever, length of illness, comorbidity, intraoperative bowel condition, bowel resection was done and length of hospital stay after operation were independent significantly associated factors with the surgical management outcome of intestinal obstruction. Conclusion: The unfavorable management outcome of patients with IO who treated surgically at the study area was high. Assessing co-morbidity, fluid resuscitation, administration of prophylactic antibiotics before operation and properly applying infection prevention protocol are some of the activities that need emphasis in intestinal obstruction management. Highlights