Background : Bowel anastomosis is one of the commonest procedure done in surgical practice, and its outcome influence by many factors include; patients, technical, and operation basis, but intraoperative blood transfusion (BT) is discriminated from other risk factors in that; its intentionally added risk factor. Objective: To evaluate the effect of blood transfusion in outcome of elective bowel anastomosis in Khartoum teaching hospital. Patient And Method: Twenty eight patients admitted into Khartoum teaching hospital, and underwent elective bowel anastomosis were enrolled in the study. Data was collected by questionnaire for each patient. Result: The total number of patients was 28, 18 were male and 10 were female, mean age was 50years, 14.3% were underwent small bowel anastomosis, 85.7% were underwent large bowel anstomosis, and 35.7% were transfused intraoperatively. Regardless other risk factors the incidence of surgical site infection (SSI) was significantly high in transfused patients, in comparison to nontransfued 30% vs 0.0%, also there was a high rates of other complications in transfused patients than those weren’t. Conclusion: Intraoperative blood transfusion is a good predictor for development of complications in elective bowel anastomosis.