Imaging Case of the Week 173 Answer

The abdominal x-rays show dilated fluid filled small bowel loops in the left mid abdomen, in keeping with small bowel obstruction.

The erect abdominal x-ray shows string of pearls sign. This sign is due to rows of gas bubbles trapped between the valvulae conniventes.

String of pearls sign

The x-rays also show stack of coins sign. This sign is caused by prominent valvulae conniventes in the small bowel crossing the entire width of the bowel loop.

Stack of coins sign