Familial Mediterranean fever (FMF) is a disease characterized by recurring and self-limiting attacks of febrile serosal inflammation involving the peritoneal, synovial, and pleural membranes. Peritonitis is the most common clinical picture of FMF, and repeated acute abdominal episodes may result in formation of peritoneal adhesions that may cause adhesive small bowel obstruction (ASBO) requiring surgical intervention. This subject has neither been clarified nor thoroughly evaluated in the literature. The records of 355 pediatric patients diagnosed to have FMF were reviewed in order to clarify the incidence and outcome of ASBO without prior laparotomy during the course of FMF. The incidence rate has been found as 3% with no mortality. This figure shows ASBO to be the most frequent complication of FMF. Therefore this life-threatening surgical emergency should be kept in mind in the differential diagnosis of acute abdominal attacks during the course of FMF.