Stepladder sign

The stepladder sign is a radiological finding observed in the context of small bowel obstruction on abdominal X-rays or computed tomography scans. It refers to the appearance of multiple, dilated small bowel loops arranged in a step-like configuration, typically visible in upright or lateral decubitus imaging positions. This sign is indicative of bowel obstruction and is used to identify and localize the site of obstruction, aiding in diagnosis and management. ^[1]

Pathophysiology

In small bowel obstruction, a mechanical or functional blockage prevents normal passage of intestinal contents leading to increased peristaltic effort in the dilated loops causing bowel loops proximal to the obstruction to dilate. Gas and fluid accumulates proximal to the obstruction. ^[2]

Imaging features

• Plain Radiography, upright or lateral decubitus views: Multiple air-fluid levels in dilated small bowel loops and step-like arrangement of loops descending toward the pelvis. ^[3]
• Computed Tomography (CT): Clearly delineates dilated loops arranged in a stepwise pattern. CT can also be used to identify the transition point (site of obstruction) and underlying cause. Complications such as ischemia, strangulation, or perforation, if present, can also be identified in CT.

References

1. Hiatt, Kevin D.; Dyer, Raymond B. (1 March 2017). "The stepladder sign" . Abdominal Radiology. 42 (3): 975–976. doi:10.1007/s00261-016-0933-2. ISSN   2366-0058. PMID   27714419 . Retrieved 3 January 2025.
2. James, B; Kelly, B (September 2013). "The abdominal radiograph". The Ulster Medical Journal. 82 (3): 179–87. PMC   3913410 . PMID   24505155.
3. Abhijit, Raut (2020). "Abdominal Radiograph" (PDF). Journal of Gastrointestinal and Abdominal Radiology. 3: S22 –S34. doi:10.1055/s-0040-1701327 . Retrieved 3 January 2025.