Paracolic Gutter Fluid Collection

Abscess or as a result of pancreatitis perforation or bile peritonitis can simulate a cystic mass.

Paracolic gutter fluid collection.

Fluid collections developing from body and tail of pancreas form in the lesser sac. The necrosed pancreatic parenchyma and or peripancreatic fatty tissue is present within the fluid collection in won and may gradually liquify. A less obvious medial paracolic gutter may be formed especially on the right side if the colon possesses a short mesentery for part of its length. There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen.

Where is the fluid. Magdy said anatomy series abdomen 12 subphrenic spaces and paracolic gutters v1 duration. The right lateral paracolic gutter. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon.

Fluid may collect anteriorly as a result of the capillary effect of the narrow space between bowel loops and viscera. Fluid may sit within the peritoneal space or paracolic gutters or may be interposed between bowel loops or around solid organs e g. As was mentioned earlier fluid collections in the paracolic and left inframesocolic spaces may communicate with the pelvic spaces fig 10. Paracolic gutters function to drain fluid that leaks from the colon such as infectious matter pus or bile and to prevent infection or damage to the outer margin of the colon.

In a supine position gravity causes fluid in the upper abdomen to flow from the left upper quadrant and right paracolic gutter into the right upper quadrant. Dense fluid may suggest hemoperitoneum especially in the context of trauma. In a study of patients with ascites from liver disease 92 had ascites around the liver 77 in the pelvis 69 in the paracolic gutters and 63 in morison s pouch. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end.

The left medial paracolic gutter. Secondly we have to realize that any loculated fluid collection due to infection i e. The main paracolic gutter lies lateral to the colon on each side. Pathologic fluid can pass between the supracolic and infracolic compartments via the paracolic gutters the peritoneal spaces lateral to the ascending and descending colon.

Fluid on ct is relatively hypodense dark on ct. The paracolic gutter is associated with a subphrenic abscess. Interfascial spread is another method of communication between the abdomen and pelvis and also allows communication across the midline through the retromesenteric plane. This drainage occurs in much the same way that the gutters on a house draw the rain off the roof.