What causes String-of-Pearls Sign in the small bowel on plain abdominal radiographs?
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Answer:
The String-of-Pearls Sign is caused by mechanical small bowel obstruction, where dilated loops of small intestine filled with fluid trap small gas bubbles between the closely apposed valvulae conniventes (mucosal folds). This sign is typically seen on upright or decubitus abdominal radiographs. It reflects the accumulation of multiple small gas bubbles lined up in a row or series within the dilated, fluid-filled small bowel loops, indicating increased intraluminal pressure and impaired bowel motility.
Why is it called so?
It is called the String-of-Pearls Sign because the trapped gas bubbles appear as a linear row of small, rounded or oval gas pockets on the radiograph, resembling a string of pearls or beads aligned along the bowel wall.
Pathophysiology
In mechanical small bowel obstruction, distal bowel obstruction causes proximal accumulation of fluid and gas. The bowel dilates and fluid surrounds the bowel lumen, creating a meniscus effect that shapes the entrapped intraluminal gas bubbles into discrete rounded pockets. These gas pockets become visible between the valvulae conniventes, which are closely spaced mucosal folds of the small intestine, resulting in the characteristic linear arrangement of gas bubbles.
Alternative names: String-of-Beads Sign
Other associated named signs: None
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