Systemic sclerosis (SSc) can lead to small bowel obstruction (SBO) through progressive smooth muscle atrophy and fibrosis, causing hypoperistalsis. Despite its clinical relevance, data on SBO outcomes in SSc remain limited. This study evaluates these outcomes using a large multi-institutional database. This retrospective cohort study utilized TriNetX global research network. Adults ≥ 18years were categorized into two cohorts: those with both SBO and SSc (Cohort A) and those with SBO alone (Cohort B). Outcomes assessed over a 20-year period (2005- 2025) included all-cause mortality, sepsis, malnutrition, DVT/PE, GI bleeding, bowel perforation, small intestinal bacterial overgrowth (SIBO), inpatient hospitalizations, and use of total parenteral nutrition (TPN). Propensity score matching was used to balance baseline demographic and clinical characteristics. After matching, 2,323 patients were included in each cohort. Cohort A had higher all-cause mortality (30% vs. 20%; RR 1.46, p < 0.001) and reduced 5-year-survival (61% vs. 73%; p< 0.001). SSc patients were more likely to develop malnutrition (RR 1.64, p< 0.0001), and sepsis (RR 1.24, p < 0.001). While absolute risks of DVT/PE and GI bleeding were similar, cumulative incidence was higher in Cohort A. No significant differences were observed in the risk of bowel perforation, SIBO, or TPN use. SSc had more hospitalizations (mean 8 vs.7; p =0.003). Patients with SSc and SBO had significantly worse outcomes, including higher mortality, malnutrition, sepsis, and greater healthcare utilization. These findings underscore the need for heightened surveillance and proactive management in this high-risk population.