What causes Stepladder appearance in small bowel on erect abdominal radiograph?
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Answer:
Stepladder appearance is caused by multiple air-fluid levels in stacked, distended small bowel loops due to small bowel obstruction from mechanical blockage by adhesions, hernias, tumors, or strictures on an erect abdominal radiograph.
Why is it called so?:
Resembles rungs of a stepladder formed by parallel horizontal air-fluid levels stacked vertically in superimposed dilated bowel loops.
Pathophysiology
Proximal small bowel dilates with gas and fluid accumulation due to distal mechanical obstruction; on an erect abdominal radiograph, hydrostatic pressure creates multiple horizontal air-fluid levels that align in a stepladder pattern when loops overlap.
Alternative names: None
Other associated named signs: String of pearls sign
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