Background: Malignant bowel obstruction is a severe complication of advanced intra-abdominal and extra-abdominal cancers. In resource-limited settings, delayed presentation, limited access to endoscopic palliation, and reliance on emergency surgery may worsen outcomes. This study aimed to identify factors associated with mortality among patients managed for malignant bowel obstruction in two tertiary hospitals in Douala, Cameroon. Methods: We conducted a retrospective multicenter analytical study in the visceral surgery departments of Douala General Hospital and Laquintinie Hospital of Douala from January 1, 2019, to December 31, 2024. All patients managed for confirmed malignant bowel obstruction were included. Patients with benign obstruction or unusable medical records were excluded. Sociodemographic, clinical, paraclinical, tumor-related, therapeutic, and outcome variables were analyzed. The primary outcome was postoperative mortality. Logistic regression analysis was used to identify factors associated with mortality, and statistical significance was set at p < 0.05. Results: Among 287 cases of intestinal obstruction, 50 were of malignant origin, corresponding to 17.4% of intestinal obstructions. Malignant bowel obstruction represented 3.7% of acute abdominal emergencies during the study period. The mean age was 53.0 ± 15.0 years, with a male predominance of 68% and a sex ratio of 2.1. The colon was the most frequent tumor site, particularly the rectosigmoid junction. Computed tomography was performed in 64.0% of cases. Laparotomy was performed in 44 patients (88.0%). The most common surgical procedures were resection with stoma formation and resection with anastomosis. The postoperative mortality rate was 22%. Factors associated with mortality included previous abdominal surgery, vomiting, preoperative dehydration, poor performance status, complete bowel obstruction, immediate emergency surgery, and resection with stoma formation.