Small bowel obstructions (SBO) are a common surgical condition with significant morbidity and mortality. Small bowel follow-through contrast studies can be used to for diagnostic and/or therapeutic effects. Typical appearances of a SBO on a water-soluble contrast challenge include dilatation of the small bowel without opacification of the large bowel. Perforation is a late complication of small bowel obstruction; in this case Gastrografin was the preferred contrast agent over barium because of the risk of barium peritonitis.