Introduction: Intestinal obstruction is a common surgical emergency associated with significant morbidity and mortality, particularly when complicated by bowel ischemia and strangulation. Early identification of patients at risk for poor outcomes remains a clinical challenge. Serum lactate, a biomarker of tissue hypoxia and anaerobic metabolism, has been proposed as a useful prognostic indicator in acute abdominal conditions. This study aimed to evaluate the role of serum lactate levels in predicting severity, need for surgical intervention, and mortality in patients with intestinal obstruction. Materials and Methods: A prospective observational study was conducted on 120 patients diagnosed with intestinal obstruction admitted to a tertiary care hospital. Serum lactate levels were measured at admission. Patients were categorized into two groups: lactate <2 mmol/L and ≥2 mmol/L. Clinical parameters, operative findings, complications, and mortality were recorded. Statistical analysis was performed using SPSS version 25.0. Results: Elevated serum lactate (≥2 mmol/L) was significantly associated with bowel ischemia (p<0.001), need for emergency surgery (p<0.01), postoperative complications (p<0.01), and mortality (p<0.001). Mean lactate levels were significantly higher in patients with gangrenous bowel compared to viable bowel. Conclusion: Serum lactate is a reliable and early prognostic marker in intestinal obstruction. Elevated levels correlate strongly with bowel ischemia, surgical intervention, and mortality. Routine measurement may aid in risk stratification and timely management.