The records of 38 patients with advanced carcinoma of the ovary and 21 patients with peritoneal carcinomatosis of other origin who were treated for relief of intestinal obstruction were retrospectively analyzed. An explorative laparotomy was performed upon 40 instances, whereas in 25 instances, a large bore draining tube gastrostomy was done primarily. Retrospectively, the 40 explorative laparotomies were performed in two separate groups of patients. The first group consisted of 15 patients without palpable masses or ascites and five patients with intestinal obstruction as the first sign of ovarian disease. Another group of 20 patients presented with clinically manifest ascites or palpable masses, or both. The patients in group 1 survived for a median time of 154 days (range of 29 to 1,086 days) without recurrent intervention for obstruction. The patients in group 2 died after a median time of 36 days (three to 151 days). The explorative laparotomy was successful in only one patient in group 2. A third group of 25 patients was deemed inoperable and primarily received a tube gastrostomy. Twenty-three patients presented with ascites or palpable masses, or both. They died after a median time of 33 days (eight to 163 days). Surgical therapy for relief of intestinal obstruction should only be considered in patients who do not present with manifest ascites or palpable masses and in patients with carcinoma of the ovary for whom effective chemotherapy is available. Percutaneous gastrostomy should be the method of choice for other patients.