Timely recognition and treatment of small bowel obstruction is of great importance for the course of the disease. Complete obstruction of the small bowel can lead to serious complications such as bowel ischaemia and perforation. Gastrografin, which is traditionally used as an oral contrast agent in imaging diagnostics, is of prognostic and therapeutic value in patients presenting with adhesive small bowel obstruction. CT is necessary to rule out closed loop obstruction or other than adhesive causes of the bowel obstruction before using Gastrografin. Patients with closed loop obstruction can rapidly develop bowel ischaemia and immediate surgery is indicated once diagnosed. Awaiting clinical resolution of the small bowel obstruction without surgery is justified when closed loop obstruction has been ruled out, there are no signs of bowel ischaemia and an abdominal radiograph within 4-24 hours after administration of Gastrografin shows the oral contrast in the colon.