Question

Identify the condition shown in the image. The X-ray reveals distended small bowel loops with air-fluid levels that appear stacked on top of each other (stepladder sign).

• A. Intestinal obstruction
• B. Valvulae conniventes
• C. Haustrations
• D. None

Hint:

The stepladder pattern of air-fluid levels on an erect abdominal X-ray is the hallmark of small bowel obstruction.

Answer 1

The Correct Option is A

Stepladder sign -- intestinal obstruction:

Radiological features of small bowel obstruction (SBO) on erect abdominal X-ray:
1. Stepladder sign: Multiple dilated small bowel loops with air-fluid levels at different heights in the same loop, stacked like the rungs of a ladder
2. Central loops: Small bowel occupies the central abdomen (vs. peripheral colon)
3. Valvulae conniventes: Mucosal folds crossing the full width of the bowel lumen (distinguish from haustrations of colon, which are incomplete)
4. Paucity of colonic gas: Gas absent distal to the obstruction

Small bowel vs. large bowel differentiation on X-ray:
| Feature | Small Bowel | Large Bowel |
|---|---|---|
| Location | Central | Peripheral |
| Folds | Valvulae conniventes (complete) | Haustrations (incomplete) |
| Diameter | $<3$ cm normal; $>3$ cm dilated | $<6$ cm normal (cecum $<9$ cm) |

MC cause of SBO: Adhesions (post-surgical, ~60-70% of cases), followed by hernias and malignancy.

\[\boxed{\text{Answer: A -- Intestinal obstruction}}\]