'String of beads' appearance on abdominal X-ray is seen in
Ans. a (Small bowel obstruction) (Ref. Grainger's Diagnostic Radiology 4th/pg. 981, 1089)FeaturesSmall bowelLarge bowelHaustraAbsentPresentValvulae conniventesPresent in jejunumAbsentNumber of loopsManyFewDistribution of loopsCentralPeripheralDiameter of loopSmallLargeRadius of curvature of loop30-50 mm50 mmSolid faeces (only reliable sign)AbsentMay be presentString of beads sign+-SMALL BOWEL OBSTRUCTION# Erect films show multiple fluid levels and dilated gas-filled loops of small bowel are readily identified on supine film. Dilated fluid-filled loops of small bowel may be seen as 'sausage shaped' soft tissue densities. "String of beads sign" (gas trapped between valvulae conniventes only when very dilated small bowel is almost completely fluid filled and it is virtually diagnostic of small bowel obstruction), "step-ladder" appearance in low obstruction (the greater the number of dilated bowel loops, more distal is the site obstruction) and the "concertina effect" in jejunal obstruction are known features. Single/multiple loops of >2.5-3 cm in diameter with three air-fluid levels in erect film (candy-cone appearance) is a helpful feature.# Enteroclysis is proving to be reliable for investigating suspected small bowel obstruction and can differentiate postoperative obstruction from ileus.# Although enteroclysis is more reliable in patients with partial, incomplete and intermittent obstruction, CT is now recommended as the technique of choice for the investigation of suspected intestinal obstruction. Small intestinal obstruction is differentiated from paralytic ileus on CT by demonstrating a transitional zone between dilated loops of small intestine proximal to the site of obstruction and collapsed loops of small intestine or colon distal to the site of obstruction.Educational points:X-ray appearanceDiagnosis'String of beads' signSmall bowel obstructionCupola signPneumoperitoneumRigler's double wall signPneumoperitoneumFootball signPneumoperitoneumCoffee bean signSigmoid volvulus (and Strangulated bowel obstruction)Pseudobilroth appearanceCrohn's disease'Bird of pre/ signSigmoid volvulus'Coiled-spring' appearanceIntussusception'Claw' signIntussusception'Saw-toothed' appearanceDiverticulosisHat signColonic polyp'Apple core' appearanceCarcinoma colon'Thumb-print' signIschemic colitisReverse '3' sign of FrostburgCarcinoma head of pancreasMoulage signMalabsorption (Celiac disease)String sign of KantorCrohn's diseaseString sign (Ba Meal)CHPSBull's eye lesionLeiomyoma (GIST) & Liver candidiasis (USG)Mucosal granularityEarliest sign of ulcerative colitis on Ba enema
Small bowel obstruction
Large bowel obstruction
Meconium ileus
Gastric outlet obstruction
G.I.T.