Radiographic Features of a Plain X-ray of the Abdomen

Radiographic Signs of Bowel Obstruction and Paralytic Ileus

A plain abdominal X-ray remains an essential diagnostic tool in radiology, especially for evaluating bowel obstruction and paralytic ileus.

Bowel Obstruction

• Dilated loops of bowel: Significantly dilated small bowel loops (>3 cm) with air-fluid levels.
• Step-ladder appearance: Multiple air-fluid levels arranged in a stepwise manner.
• String of pearls sign: Small pockets of air trapped between valvulae conniventes in the small bowel.
• Gasless abdomen: Indicates complete obstruction with minimal air in the bowel lumen.

Paralytic Ileus

• Generalized bowel distension: Diffuse dilatation affecting both small and large intestines.
• Absence of peristalsis: No organized air-fluid levels.
• Uniform gaseous distension: Presence of gas throughout the bowel without transition point.

Additional Imaging Considerations

While plain X-ray offers rapid assessment, further imaging such as CT or ultrasound may be required to confirm diagnosis and evaluate for complications.