Imaging Case of the Week 195 Answer

The erect abdominal x-ray shows paucity of gas in the abdomen. There are multiple areas of small gas bubbles which are arranged in a row, thus giving rise to the ‘string of pearls’ sign. In the context of appropriate clinical presentation, this sign is suggestive of advanced small bowel obstruction.

string of pearls sign

This sign may also be seen in acute gastroenteritis. Hence, clinical correlation is important.