String sign of kantor is a radiological feature of:
Correct Answer: Crohn's disease
Description: Ans. A (Crohn's disease). (Ref. Bailey & Love surgery 25th ed. 1171) Barium study features of Crohn's disease Radiological feature Ulcerative colitis Crohn's disease Crohn's disease: 1 Mucosal Granularity ++ +- The best investigation of the small intestine is small bowel enema (enteroclysis). In Crohn's disease, this will show up areas of delay and dilatation. The involved areas tend to be narrowed, irregular and, sometimes, when a length of terminal ileum is involved, there may be the strine sien of Kantor. Sinograms are useful in patients with enterocutaneous fistulae. CT scans are used in patients with fistulae and those with intra-abdominal abscesses and complex involvement. Magnetic resonance imaging (MRI) has been shown to be useful in assessing perianal disease. 2 Cobble-stoning - + 3 Aphthoid ulcers - ++ 4 Fissuring ulcers - ++ 5 Haustra blunted ++ + 6 Gen. narrowing and shortening (hose-pipe) ++ - 7 'String sign' of Kantor - + 8 Widened postrectal space ++ +- 9 Transmural + - 10 Pseudodiverticuli - ++ 11 Rectum involved ++ + 12 Continuity ++ +- 13 Skip areas - + 14 Backwash ileitis + - 15 Multiple anal fistulas - + 16 Enteroenteric fistula - + 17 Perforation + - Toxic megacolon +- Carcinoma + +- # Enteroclysis followed by a barium enema may be the best protocol for evaluation of intestinal tuberculosis. Barium features of Ileocaecal tuberculosis # i). Early involvement of the ileocaecal region manifesting as spasm and edema of the ileocaecal valve ("Fleischner" or "inverted umbrella sign") are characteristic. # ii). Fold thickening and contour irregularity of the terminal ileum, better appreciated on double contrast study. # iii)."Conical/ Amputed/ Contracted pulled-up caecum" . # iv). Loss of normal ileocaecal angle and dilated terminal ileum, appearing suspended from a retracted, fibrosed caecum ("goose neck deformity"). Widening of IC angle (Normal is 90) is a common feature. # v)."Purse string stenosis"- localized stenosis opposite the ileocaecal valve with a rounded off smooth caecum and a dilated terminal ileum. # vi)2'Stierlin sign" is a manifestation of acute inflammation superimposed on a chronically involved segment and is characterized by lack of barium retention in the inflamed segments of the ileum, caecum and variable length of the ascending colon, with a normal configured column of barium on either side. It appears as a narrowing of the terminal ileum with rapid emptying into a shortened, rigid or obliterated caecum. # vii)."String sign" - persistent narrow stream of barium indicating stenosis. Also remember: # String sign is also a Barium study feature of CHPS characterized by Passing of small barium streak through pyloric canal seen as a string of barium.
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