OBJECTIVE Over the past 50 years acute intestinal obstruction has remained among the commonest causes of the acute abdomen, along with peritonitis, appendicitis and gastrointestinal perforations. However several observers have noticed over the past 2 decades a shift in the etiological spectrum. The study aims at ascertaining the precise nature of the change. METHODS Published data on intestinal obstruction from the Korle Bu Teaching Hospital over the past 50 years were reviewed, as the consistent report format permitted ready comparison of the series. Emphasis was placed on clinical features, established cause and resulting complications. RESULTS The case load of intestinal obstruction has dwindled over the past 3 decades, accounting for 0.7% of all hospital admissions compared with 1.4% 30 years earlier. External hernias together with adhesive bands still constitute the bulk of presenting cases, but the proportions have changed with strangulated hernias accounting for 59.8% instead of 77.6%. The change has paralleled a rise in elective hernia day case surgery. The incidence of intussusception has almost doubled (7.4% from 4.0%) and it still afflicts the very young. Colonic neoplasms have been commoner over the past 2 decades although the incidence (3.3%) falls short of Western figures. Overall mortality has remained unchanged at 9.4% and this has been associated with a rise in resection rates to 18.3%. CONCLUSIONS The patterns of intestinal obstruction have been much influenced by changing attitudes regarding elective hernia surgery and evolving financial policies.