Mechanical small bowel obstruction (SBO) remains a common clinical problem despite ever-increasing medical and surgical advances. The predominant etiology continues to be postoperative adhesions, accounting for approximately two-thirds of all obstructive events. As opposed to high-grade or complete small bowel obstruction where the clinical and radiographic findings are typically more diagnostic and the treatment plan more defined, partial SBO represents a subgroup, where the evaluation is more arduous, the diagnosis more elusive, and the management less defined. Operative and nonoperative approaches to treatment are successful and are based on the etiology and clinical status of the patient. A paradox remains, however, treating a predominantly surgically induced condition with repeated operations. Several advances in the treatment and prevention of SBO have become practice in past decade. This article reviews the clinical issues and technical advances of this challenging condition.