Introduction: Small bowel obstruction is one of the most common surgical emergencies and the main causes of hospital admissions. Emergency surgical procedure is necessary when strangulation or complete obstruction occurs (1,2,3,4). Gastrografin, is hyperosmolar water-soluble contrast agent, makes the fluid move into the intestinal lumen and increases the pressure gradient across obstructive sites that may result in resolving the obstruction (5,8). If the symptoms are still present after 24 to 48 hours, surgery is indicated(4). While many studies have shown the diagnostic benefit of gastrografin, the therapeutic advantage was not found by other authors (6) . Objective: The aim of this study was to evaluate the therapeutic role of gastrographin in management and assessing the indication for surgical intervention in patients with small bowel obstruction. Patients and Methods: In this prospective study, gastrografin was given to patients diagnosed with small bowel obstruction in clinical and radiological grounds. The contrast passage was assessed by CT or serial X-ray and accordingly, The patients were divided into two groups: group (A), who were improved by gastrografin administration, and group B, who finally required surgery. Results: Fifty two patients were included in the study. forty one of them (78.8 %) received a non-operative course in whom the contrast was observed in the large bowel. They had a mean hospital stay of 4 days. eleven patients (21.2 %) required operative intervention. These patients had a mean hospital stay of 8 days. Conclusion: This study has demonstrated that gastrografin helps to assess and reduce the indication for surgical interference and hospital stay for cases presented with acute small bowel obstruction Keywords: Diatrizoate; Meglumine; Intestinal Obstruction; Surgery.