String of pearls sign (gastrointestinal)

Last revised by Dr Matt A. Morgan on 19 Jan 2021

The string of pearls (or beadssign can be seen on upright or decubitus abdominal radiographs as well as on CT in patients with small bowel obstruction, increased intraluminal fluid, and slow resorption of intraluminal gas.

It consists of an obliquely or horizontally oriented row of small gas bubbles in the abdomen, which represent small pockets of gas along the superior wall of the small bowel that are trapped between the valvulae conniventes. The inferior margins of these bubbles have an ovoid appearance due to the meniscal effect of the intraluminal fluid.

The string of pearls sign, when present in the appropriate clinical setting, is virtually diagnostic of small bowel obstruction. Although rare, it may also be seen in adynamic ileus, acute gastroenteritis, and saline catharsis.

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