Diagnostic, Prognostic, and Therapeutic Roles of Water-Soluble Contrast in Adhesive Small Bowel Obstruction: A PRISMA-Guided Narrative Systematic Review.

Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by postoperative adhesions. Although many patients improve with bowel rest, nasogastric decompression, intravenous fluids, and electrolyte correction, delayed operative intervention in patients unlikely to resolve nonoperatively can increase morbidity. Water-soluble contrast (WSC) agents such as Gastrografin, Urografin, and related diatrizoate preparations have been proposed as diagnostic, prognostic, and potentially therapeutic adjuncts. In this article, we review the available clinical evidence on the use of WSC in adult adhesive or postoperative small bowel obstruction (SBO) and examine whether its primary role is diagnostic and prognostic rather than therapeutic. A structured narrative review was conducted in accordance with PRISMA guidelines, using studies identified through PubMed, Excerpta Medica database (Embase), and manual searches. Eligible studies included adult patients with adhesive, postoperative, or non-strangulated SBO who received oral or nasogastric WSC and reported clinical outcomes such as passage of contrast, obstruction resolution, operative intervention, hospital length of stay, or complications. Randomized trials, prospective observational studies, retrospective cohort studies, and protocol evaluations were included. Due to differences in study design, patient populations, contrast protocols, and outcome definitions, the findings were synthesized narratively. Twenty-one primary clinical studies met the inclusion criteria and were included in the review. Several studies demonstrated faster resolution of obstruction, shorter hospital stays, and lower rates of surgery. However, other studies did not show significant improvements in these outcomes. These discrepancies are likely due to differences in study design, patient selection, timing of contrast administration, and variations in WSC challenge protocols. In contrast, the prognostic value of WSC was consistent across studies, as the progression of contrast to the colon was reliably associated with successful nonoperative management. Overall, the evidence suggests that the primary value of WSC lies in its diagnostic and prognostic roles, while its therapeutic benefit remains uncertain.