Background: The aim of this study was to assess the diagnostic and therapeutic role of urografin (water soluble contrast agent) in patients with adhesive small bowel obstruction.Methods: This was a prospective study conducted in the department of surgery in association with the department of Radiology, in S.C.B.M.H, Cuttack. Odisha India. Total patients with clinical and radiological evidence of adhesive SBO were selected for this study. The primary outcome in the diagnosis role of WSCA was its ability to predict the need for surgery.in the therapeutic role, the following were evaluated, resolution of SBO without surgery, time from admission to resolution, duration of hospital stays, complications and mortality.Results: 129 prospective patients were included. The appearance of contrast in the colon within 4-24 Hrs, after administration had a sensitivity of 96 percent and specificity of 98 percent in predicting resolution of SBO.Conclusions: Water soluble contrast agent (urografin) was effective in predicting the need for surgery in patients with adhesive SBO. In addition, it reduced the need for operation and shortened hospital stay.