STRANGULATION is a serious threat to life in intestinal obstruction. When this complication develops, immediate diagnosis and surgical intervention are mandatory to avoid mortality. Proper diagnosis of strangulation requires the integration of history, physical examination, laboratory study, and radiologic signs. It is the purpose of this report to draw attention to certain radiologic features occasionally found in intestinal obstruction which are highly suggestive of strangulation although not commonly recognized.
Once a mechanical barrier to the normal passage of fluid and gas along the intestinal tract develops, a sequence of events ensues which produces wellknown signs and symptoms. Associated with these are characteristic radiologic findings which result from the accumulation and stratification of gas and fluid in distended loops of intestine. These include "hairpin" turns, "stepladder" arrangement of coils, central distribution of gas and fluid-filled segments of small bowel, and little or no gas distal to the point of obstruction. Great