Pancreatic Drainage Into Paracolic Gutter

In cases where necrosis extends into one or both paracolic gutters and or into the pelvis the dependent portions of the collection will not be able to drain effectively through superiorly located transmural endoscopic.

Pancreatic drainage into paracolic gutter.

Fluid collections developing from body and tail of pancreas form in the lesser sac. When other peripancreatic collections expanded widely to paracolic. The main paracolic gutter lies lateral to the colon on each side. These collections are in close proximity to posterior wall of the stomach and thus amenable for internal drainage into the stomach.

Strongly considered as an adjunct to endoscopic drainage for won with deep extension into the paracolic gutters and pelvis or for salvage therapy after endoscopic or surgical debridement with residual necrosis burden. Paracolic gutters help keep infectious material away from the body s internal organs. Two patients patients 8 and 12 developed recurrent pseudocysts after 2 and 4 months respectively. Of necrotic collections that extend into the paracolic gutter.

Both paracolic gutters run laterally along the back side of the abdominal wall and are situated between the abdominal wall and the outer margin of the colon. Pfcs may also extend to left paracolic space. Best practice advice 9. The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly.

Consecutive patients with symptomatic won extending into the retroperitoneum were included in a prospective registry. The left medial paracolic gutter. Percutaneous drainage should be employed when endoscopic drainage is unavailable unsuccessful or not technically feasible. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically.

This patient was asymptomatic during the last follow up. When disruption of the pancreatic duct with leak was evident a pancreatic duct stent was placed using standard endoscopic techniques 25. In a supine patient the peritoneal fluid tends to collect under the. A less obvious medial paracolic gutter may be formed especially on the right side if the colon.

The right lateral gutter is much larger and allows for greater drainage than the left gutter. Self expanding metal stents in the form of lumen apposing. Recently endoscopic necrosectomy has become the mainstay for management. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon.