Objective <p>Early identification of strangulation in adhesive small bowel obstruction (SBO) is crucial for emergency triage and immediate surgical intervention. This study aimed to explore the predictive value of the immature granulocyte (IG) count in assessing strangulation in adhesive SBO.</p> Methods <p>This was a retrospective analysis of patients with adhesive SBO, diagnosed surgically or by abdominal computed tomography (CT) from May 2022 to April 2025, comparing strangulated (SG) and non-strangulated (NSG) cases. Baseline levels of the IG count and related inflammatory biomarkers were analyzed using logistic regression analysis and receiver operator characteristic (ROC) curves to assess the predictive value for strangulation.</p> Results <p>250 eligible patients in the SG (<i>n</i> = 167) and NSG (<i>n</i> = 83) groups were enrolled in this study. Compared to the NSG group, the SG group demonstrated significantly higher levels of white blood cell count (WBC), neutrophil (NEU), neutrophil-to-lymphocyte ratio (NLR), and IG count with statistical differences (all <i>P</i> &lt; 0.001). In the analysis of logistic regression and ROC, the IG count demonstrated an independent risk for predicting strangulated adhesive SBO (OR 15.41, 95%CI 8.07–31.59, <i>P</i> &lt; 0.001). The IG count had the highest area under the ROC curve (AUC) of 0.946 among the enrolled inflammatory biomarkers, particularly within 6&#xa0;h from onset to hospital (AUC 0.961, 95% CI, 0.90-1.00). It showed an optimal cutoff value of 0.280 *10⁹/L with a sensitivity of 89.50% and specificity of 100.00% for identifying strangulation in adhesive SBO.</p> Conclusion <p>IG count was an early predictor for quick detection of strangulation in adhesive SBO within 6&#xa0;h from onset to hospital. This finding may fill the clinical gap in recognizing intestinal ischemia at an early stage prior to imaging examination .</p>