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

Step 1: Interpret the radiological finding.
The stepladder sign (also called the stepladder pattern) is a classic radiological sign seen on an erect abdominal X-ray. It describes multiple distended small bowel loops with air-fluid levels that appear to be stacked on top of each other, resembling the rungs of a ladder.

Step 2: Identify the diagnosis.
The stepladder sign is pathognomonic of small bowel obstruction (SBO), which falls under the broader category of intestinal obstruction.

Additional radiological features of intestinal obstruction:
- Distended loops of bowel (central, small bowel loops -- identified by valvulae conniventes/plicae circulares which cross the full width of the bowel)
- Multiple air-fluid levels at different heights in the same loop (step-ladder pattern)
- Paucity of gas in the colon (collapsed colon distal to obstruction)

Step 3: Differentiate the other options.
- Valvulae conniventes: These are the mucosal folds of the small bowel (also called plicae circulares or Kerckring's folds) -- they are a structural feature of the small bowel, visible on X-ray in small bowel obstruction, but are NOT themselves the condition/diagnosis.
- Haustrations: These are the sacculations (pouches) of the large bowel wall, seen on X-ray as incomplete bands (unlike valvulae conniventes which cross the full width). They indicate large bowel, not the diagnosis here.
- None: Incorrect -- the image clearly shows intestinal obstruction.

Conclusion: The condition shown is intestinal obstruction (specifically small bowel obstruction, diagnosed by the stepladder sign).