On small bowel barium follow-through, 'Floculation' and 'segmentation' of the barium column are radiological signs of:

• A Crohn's disease with skip lesions
• B Small bowel obstruction with air-fluid levels
• C Intussusception with coiled-spring appearance
• D Malabsorption syndrome with altered secretion and motility ✓

Explanation

Flocculation (clumping of barium into irregular masses) and segmentation (separation of the barium column into fragmented segments) occur due to altered bowel secretions and motility in malabsorption syndromes. The excessive mucus and fluid in the bowel lumen disrupt the normal continuous barium column. These findings, along with dilated bowel loops and 'moulage sign' (featureless tube-like appearance), are classic for celiac disease and tropical sprue. Crohn's disease shows cobblestone pattern, skip lesions, and 'string sign' of Kantor in severe stricture. Intussusception shows coiled-spring with concentric rings of barium between intussusceptum and intussuscipiens.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.