Triad of vomiting, abdominal distension and ''String of beads" sign on abdominal X-ray is typically suggestive of?

Ans. b (Small bowel obstruction). (Ref. Grainger & Allison's Diagnostic Radiology, 5th ed., 981, 1089)Erect abdomen X-ray features of small bowel obstruction:# Multiple fluid levels (3 or more than 3, size more than 3 cm and in mid-abdomen - 'candy-cone appearance).# "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.# Visualization of 'valvulae conniventes' is diagnostic feature.# Pathognomonic feature is "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).Educational points:# Standing (erect) X-ray abdomen is 'gold standard' investigation of diagnosis of bowel obstruction.# The mucosal folds of small bowel - 'valvulae conniventes', are numerous in jejunum and sparse in ileum.# On barium study, jejunum gives typical feathery appearance \ while ileum is almost featureless.# The most common cause of small bowel obstruction is post-operative adhesions.Q"STRING OF BEADS" APPEARANCE('Pile of plates' appearance)Is classically seen on angiography in FibroMuscular Dysplasia."STRING SIGN"Persistent narrow stream of barium indicating stenosis.'STRING SIGN'CHPS (a string of barium seen through pyloric canal seen in CHPS .STRING SIGN OF KANTOR'Crohn's diseaseAlso know following x-ray signs in abdomen:X-ray AppearanceDiagnosis1Double bubble sign# Duodenal atresia.# Ladd's band.# Annular pancreas2Triple bubble sign# Jejunal atresia3Multiple bubble sign# Ileal atresia4'String of beads' sign# Small bowel obstruction5Cupola sign# Pneumoperitoneum6Rigler's double wall signFoot-ball signDog's cape sign# Pneumoperitoneum7Sentinel Loop SignGas less abdomenRenal halo signColon cut-off sign# Acute pancreatitis8Coffee bean signInverted 'U' or 'V' signOmega signBent inner tube signLiver overlap signDIO overlap signApex under diaphragm# Sigmoid volvulus9Medusa Lock sign# Roundworms