Paracolic Gutter Pancreatitis

Cleaning the paracolic gutter.

Paracolic gutter pancreatitis.

There is moderate and diffuse peripancreatic fat stranding. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. The main paracolic gutter lies lateral to the colon on each side. Recently endoscopic necrosectomy has become the mainstay for management.

Transcutaneous endoscopic necrosectomy through a fully covered metal esophageal stent transgastric endoscopic necrosectomy with nasocystic lavage is accepted as one of the standards of care for the management of walled off necrosis secondary to acute pancreatitis. A less obvious medial paracolic gutter may be formed especially on the right side if the colon. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected.

The adjacent second and third segments of the duodenum demonstrate mural thickening in keeping with reactive change. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. There is a moderate volume of free intraabdominal fluid with pockets scattered through the mesentery and pooling in the paracolic gutters.