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A malignant bowel obstruction (MBO) is a common clinical complication in patients with recurrent gastrointestinal carcinoma, which has a poor prognosis and a limited life expectancy. This study considered the effectiveness of surgical management for MBO. Methods: This study reviewed the clinical course of 70 patients who underwent surgery for MBO and compared the outcomes in three groups: patients with (A) peritonitis carcinomatosis without manifest ascites, (B) peritonitis carcinomatosis with ascites, (C) local recurrence without peritonitis carcinomatosis.The 1-year survival rate and median survival time (MST) in the patients in group A were 33.3% and 228 days, which was statistically longer than those (6.7% and 46 days) in the patients in group B (P = 0.026). The rate of the patients with possible oral intake of solid meals for 6 months and median oral intake periods were 45.4% and 161 days in patients in group A and 28.0% and 93 days in patients in group C. In contrast, 66.7% in group B could not take solid meals for more than 1 month, and five patients could not take solid meals at all.Palliative operations for the patients with manifest ascites of MBO are risky and rarely effectively improve oral intake, but this is not considered to be a contraindication for surgical management. Informed consent is therefore important in the surgical management of MBO.