The stepladder sign

Excerpt

A stepladder (Fig. 1) is the visual metaphor that has long been used to describe stacked loops of dilated small bowel, as seen on supine abdominal radiographs in the setting of distal small bowel obstruction [1]. The stepladder configuration forms as pressure builds upstream from distal mechanical obstruction, causing loops of small bowel to dilate and stack in parallel. Due to constraints of small bowel mesenteric attachments, which extend obliquely from the right iliac fossa to the upper pole of the left kidney, the stack is tilted from the right lower quadrant to the left upper quadrant (Fig. 2). As the bottom step on a stepladder is the longest and broadest, the distal loops of small bowel in the right lower quadrant often appear more elongated than the more proximal loops “stacked” above [2].

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