A 60 year old patient presented with severe abdominal pain,vomitting and constipation.X ray picture is shown in the image.What can be the most possible diagnosis?
A. Peptic Ulceration
B. Large Bowel Obstruction
C. Small Bowel Obstruction
D. Acute Appendicitis
Ans:C. Small Bowel Obstruction.
Image shows:Erect abdominal radiograph of the same patient showing multiple air-fluid levels within the dilated small bowel loops.Note the valvulae conniventes
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.