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The most prevalent cause of small-bowel obstruction in an older adult, especially one with a history of abdominal surgery such as an appendectomy, is adhesions. After surgical procedures, scar tissue can form and connect different parts of the intestine or the intestine to other organs in the abdominal cavity. This scarring can restrict the normal movement of the bowel and lead to an obstruction.

Adhesions are particularly common following surgeries of the abdomen, making them a leading cause of small-bowel obstructions in this demographic. In older patients, the risk and prevalence of adhesions tend to increase due to the cumulative effects of previous surgeries.

While incarcerated hernias, intussusception, and neoplasms can also lead to small-bowel obstruction, they are less frequently the underlying cause in the context of an individual who has undergone surgical procedures like an appendectomy. Incarcerated hernias are indeed a significant cause, but their occurrence is not as common as adhesions in post-surgical patients. Intussusception is more common in children, though it can occur in adults, and neoplasms, while a potential cause, are generally less prevalent compared to the frequency of adhesions in post-operative patients.