was generalized abdominal tenderness but no mass could be palpated. Auscultation revealed tinkling and accentuated bowel sounds.
A. Acute Appendicitits
B. Small Bowel Obstruction
C. Large Bowel Obstruction
D. Peptic Ulcer
Ans:B. Small Bowel Obstruction.
- Supine abdominal radiograph showing multiple dilated small bowel loops in small bowel obstruction.
- Note the concentric linear ‘bands’ running through the bowel wall: valvulae conniventes, and the LUQ location, suggest that these are dilated jejunal loops.
SMALL BOWEL OBSTRUCTION
- Mechanical small bowel obstruction results in small bowel dilatation and the accumulation of both gas and fluid proximal to the point of obstruction. Distal to this point the calibre of small and large bowel is non-dilated/collapsed.
- Dilated (maximal diameter of normal small bowel – An erect film may show multiple fluid levels which is nonspecific and may be seen in paralytic ileus, gastroenteritis, jejunal diverticulosis, etc.
- The ‘string of beads’ sign refers to a linear chain of small gas bubbles (which are trapped between the valvulae conniventes when the dilated small bowel loops are almost completely fluid-filled) and is virtually diagnostic of small bowel obstruction .
- On an AXR it is important to differentiate small bowel and large bowel dilatation.