Some patients with small bowel obstruction (SBO) respond to conservative therapy, while others require surgery. A simple oral contrast challenge can help to determine the patient's probable course.
Patient selection: small bowel obstruction due to adhesions, with failure to improve after 48 hours of conservative management
Contrast challenge: 100 mL of water-soluble contrast material mixed with 50 mL water
Administration: through the nasogastric tube
Imaging studies are performed at 8 and 24 hours.
If contrast material has passed into the colon within 24 hours, then surgery is rarely required.
If contrast material has not passed into the colon within 24 hours, then surgery is usually required.
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