Background: Acute small bowel obstruction (SBO) is a major cause of morbidity and mortality. It results in the use of significant healthcare resources, particularly in cases of delayed proper management. The “Gastrografin challenge" has been used for decades as a diagnostic modality in (SBO), involving serial abdominal radiographs. Objective: In this study, we aimed to evaluate the diagnostic and therapeutic value of Gastrografin in small bowel obstruction diagnosis and management Methods: PubMed database was used for article selection, and the following keywords were used in the mesh: “Gastrografin Challenge” [Mesh], "Small Bowel Obstruction"[Mesh], and “Evalua-tion”[Mesh] or “Management”[Mesh] or “Diagnosis”[Mesh]. Conclusion: Gastrografin has an important role in the diagnosis and management of SBO from early recognition of complete obstruction. It has replaced the repetitive CT use and triumphed over the high contrast dose effect on patient’s health caused by CT imaging.