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Background:  Adhesive small bowel obstruction (ASBO) accounts for the majority of hospitalizations related to SBO following abdominal surgery. Delays in the management of ASBO are associated with longer hospital stays and increased mortality rates, making it imperative to establish an efficient way of determining which patients need surgical intervention., Purpose: To evaluate the contribution of bedside small bowel follow-through (BSBFT) in the management of suspected ASBO., Materials and Methods: A single-site analysis of 320 patients who underwent BSBFT from August 2015 to 2019 was retrospectively performed. The presence of contrast in the colon on abdominal radiographs obtained at eight and 24 hours after administration and subsequent management (conservative versus surgical) was recorded., Results: Of the 320 BSBFT exams, 235 cases had colonic contrast present at eight hours. Twelve of those cases received surgical treatment, while the remaining 223 were managed conservatively. Forty-three cases showed colonic contrast at 24 hours despite not showing contrast at eight hours. Of these cases, 29 patients were managed conservatively, while 14 patients underwent surgery. Forty-two cases had no contrast at 24 hours, and 33 patients of those patients subsequently received surgical intervention, while nine were managed conservatively. Patients who had contrast on radiographs and underwent surgical interventions had either high clinical concern for postoperative complications or stagnant clinical progression., Conclusion: BSBFT helps determine the management for suspected ASBO. ​Patients with colonic contrast on eight- or 24-hour abdominal images were more likely to be managed conservatively. However, the clinical context is important, since clinical factors may overrule the results of the BSBFT., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. WFU Health Sciences issued approval IRB00029848. This HIPAA-compliant retrospective study was approved by the Wake Forest University Health Sciences Institutional Review Board. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Duy et al.)