<prompt> Which of the following is the most probable diagnosis of this X ray abdomen?Gas under diaphragm- peritonitisMultiple air fluid level- adhesions and bandsBird beak - volvulusNormal X ray PA view  <response>: Ans. b Multiple air fluid level- adhesions and bandsRef.: Manual of emergency medicine 5th ed247 In X ray you can see that due to intestinal obstruction secondary to adhesions or bands, the loopsproximal to the point of obstruction will become dilated and fluid- filled and are usually greater than 2.5-3 cm in size Absence of, or disproportionately smaller amount of, gas in the colon, especially the recto-sigmoid. Loops of small bowel may arrange themselves in a step- ladder configuration from the left upper to the right lower quadrant in a distal SBO Mostly fluid-filled loops of bowel may demonstrate a string-of-beads sign caused by the small amount of visible air in those loops 