Stack of coins sign refers to the appearance of small bowel folds that are smoothly and uniformly thickened ¹. The margins between the folds are sharply delineated and the arrangement of clearly demarcated parallel folds is likened to a stack of coins or a picket fence. This sign is distinct from the hidebound-bowel sign in which the bowel folds are not thickened and is a feature of systemic sclerosis and sprue.

Pathology

The smooth regular fold thickening is caused by intramural bleeding. Bleeding into the mesentery may cause loop displacement and separation.

Cause of bleeding leading to this pattern include:

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• anti-coagulant therapy
• ischemia
• vasculitides
• coagulopathies secondary to other hematological disorders

• 1. Thickening of Small Bowel Folds. (2012) American Journal of Roentgenology. 193 (1): W1-6. doi:10.2214/AJR.09.2762 - Pubmed