Paracolic Gutter Cysts

Fluid can accumulate in lesser sac and pleural space and paracolic gutters.

Paracolic gutter cysts.

There can be extensive peripancreatic inflammation. Pancreas can show acute inflammation suppuration hemorrhage and or extensive necrosis. The right lateral paracolic gutter runs from the superiolateral aspect of the hepatic flexure of the colon down the lateral aspect of the ascending colon and around the cecum. In men the most gravity dependent site for fluid accumulation is the rectovesical space.

Hemoperitoneum starts near the site of injury and flows along expected anatomic pathways. The retroperitoneal hematoma measured 13 4 mm diameter and severely compressed the inferior vena cava ivc fig. The connection between the left paracolic gutter and the left subphrenic space is partially limited by the phrenicocolic ligament. Neutrophils infiltrate the edge of the necrotic areas and extend into the adjacent lobules of fat and produce fat necrosis.

It can be divided into two unequal spaces posteriorly by the mesentery of the small bowel as it runs from the duodenojejunal flexure in the left upper quadrant to the ileocecal valve in the right lower quadrant. These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. 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. In a male patient this is a very uncommon diagnosis.

The paracolic gutter is associated with a subphrenic abscess. Both the right and left paracolic gutters communicate with the pelvic spaces. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. When larger amounts of ascites are present the fluid accumulates in the paracolic gutters causing progressive centralization of bowel loops.

But disease history including appendicitis or mucous as coincidental finding are alternative forms of presentation. The inframesocolic space is the peritoneal space below the root of the transverse mesocolon the supramesocolic space lies above the transverse mesocolon s root. Symptoms of cancer spreading in the peritoneum the clinical profile of pseudomyxoma peritonei is normally increasing abdominal circumference and confirmation of mucous in the abdominal cavity jelly belly. Small amounts of ascitic fluid localize in the right perihepatic space the posterior subhepatic space i e morison s pouch and the pouch of douglas.

There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen. Ipsilateral psoas hematoma and fat stranding in the right paracolic gutter confirmed rupture of the hemorrhagic cyst from the right native kidney fig. The main paracolic gutter lies lateral to the colon on each side.