Objective To compare the application value between multi-slice spiral CT (MSCT) and abdominal X-ray plain film in the diagnosis of acute intestinal obstruction. Methods The clinical value of 164 patients with acute intestinal obstruction diagnosed by surgery and pathological examination in our hospital were collected. The application value of MSCT and abdominal X-ray plain film from the detection rate and pathogenesis of acute intestinal obstruction was comprehensively analyzed. Results The results of surgical and pathological examination were used as the gold standard. ①The diagnostic accuracy of abdominal X-ray plain film for acute intestinal obstruction was 70.12% (115/164) and the diagnostic accuracy of multi-slice spiral CT for acute intestinal obstruction was 98.17%. (161/164). The diagnostic accuracy of them was compared. The diagnostic accuracy of MSCT was higher than that of the abdominal X-ray film.(χ2=48.359, P=0.000). ②The diagnostic rates of abdominal X-ray plain film for pathogenesis of acute intestinal obstruction were 50.61% (83/164) and the diagnostic rates of multi-slice spiral CT for pathogenesis of acute intestinal obstruction were 96.34% (158/164). The diagnostic rate of MSCT for pathogenesis of acute intestinal obstruction was higher than that of abdominal X-ray plain film(χ2=87.995, P=0.000). Conclusion MSCT is superior to abdominal X-ray plain film in the diagnostic accuracy and pathogenesis of acute intestinal obstruction. It can provide more guiding imaging data for clinical diagnosis of diseases, and can be used as the preferred imaging examination for patients with acute intestinal obstruction.