String of pearls sign of small bowel obstruction

Case contributed by Henry Knipe
Diagnosis certain


Nausea and vomiting.

Patient Data

Age: 60 years
Gender: Male

Dilated loops of small bowel with string of pearls sign in the LUQ in keeping with a small bowel obstruction. No free gas identified.

Small bowel obstruction with dilated small bowel loops measuring up to 4.8 cm in diameter. Transition within the pelvis again noted. Small volume free fluid within the pelvis. No intra-abdominal free gas. 

Small ventral hernia containing omental fat. Left posterior diaphragmatic hernia containing part of the gastric fundus. 

Case Discussion

When obstructed small bowel is fluid filled, tiny locules of gas are present that when arranged in a line, are akin to a necklace like a string of pearls rather than the typical "wide" air-fluid levels. This patient had a history of recurrent small bowel obstructions secondary to adhesions. 

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