Paracolic Gutter Cysts

Pancreas can show acute inflammation suppuration hemorrhage and or extensive necrosis.

Paracolic gutter cysts.

But disease history including appendicitis or mucous as coincidental finding are alternative forms of presentation. 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. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. There can be extensive peripancreatic inflammation.

When larger amounts of ascites are present the fluid accumulates in the paracolic gutters causing progressive centralization of bowel loops. The paracolic gutter is associated with a subphrenic abscess. Download high res image 159kb. Hemorrhage from the liver typically flows in a caudal direction from the perihepatic spaces and hepatorenal fossa along the right paracolic gutter and into the cul de sac which is the rectouterine space in women and rectovesical space in men fig 1.

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. There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen. 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.

The inframesocolic space is the peritoneal space below the root of the transverse mesocolon the supramesocolic space lies above the transverse mesocolon s root. Neutrophils infiltrate the edge of the necrotic areas and extend into the adjacent lobules of fat and produce fat necrosis. The connection between the left paracolic gutter and the left subphrenic space is partially limited by the phrenicocolic ligament. Both the right and left paracolic gutters communicate with the pelvic spaces.

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. 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. The main paracolic gutter lies lateral to the colon on each side. The retroperitoneal hematoma measured 13 4 mm diameter and severely compressed the inferior vena cava ivc fig.

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. In a male patient this is a very uncommon diagnosis. Fluid can accumulate in lesser sac and pleural space and paracolic gutters.