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String of pearls sign

AbdomenRadiograph

A row of small gas bubbles trapped along the superior wall of a fluid-filled, distended small-bowel loop, arranged like a string of beads.

What it means

Small bowel obstruction with fluid-filled loops.

Mechanism

Small pockets of gas rise and lodge between the valvulae conniventes at the top of loops that are largely filled with fluid.

Associated conditions

  • Small bowel obstruction
  • Adhesions
  • Hernia
  • Obstructing neoplasm

Pearls

  • It is best seen on an erect film of a fluid-filled obstructed small bowel.
  • The near-absence of colonic gas supports a small-bowel level of obstruction.

References

  • Radiopaedia: String of pearls sign

For educational use only. This dictionary is a study aid and reference, not a diagnostic tool, and must not be used to guide clinical decisions or patient care. Imaging appearances vary; always correlate with the full clinical picture and confirm with a qualified radiologist.