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In certain situations it is preferable to perform small bowel examination using water-soluble contrast agents. Generally, ionic agents are used, but non-ionic agents may be an alternative in certain circumstances. We retrospectively reviewed a consecutive series of small bowel examinations using non-ionic media in order to determine their efficacy. A total of 52 water-soluble non-ionic small bowel follow-through examinations were performed in 42 patients using 100 ml iohexol. Indications for the study and the reasons why barium sulphate suspensions were contraindicated were established. Studies were assessed for radiographic quality and clinical findings were noted, and comparison was made with operative findings and clinical outcome. Obstruction was diagnosed in 12 examinations and the radiological findings were confirmed in all 7 patients surgically treated. Fistulae were identified in 11 examinations and the radiological findings were confirmed in all 8 patients who were treated by laparotomy. Additionally, at laparotomy no obstruction or fistula was found in the 5 patients in whom prior contrast examination had been negative. Non-ionic water-soluble follow-through examination is easily performed and well tolerated, allowing accurate diagnosis of obstruction and fistula when barium suspensions are contraindicated.