Pancreatic Drainage Into Paracolic Gutter

The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon.

Pancreatic drainage into paracolic gutter.

The right lateral gutter is much larger and allows for greater drainage than the left gutter. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. In a supine patient the peritoneal fluid tends to collect under the. 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.

Self expanding metal stents in the form of lumen apposing. The left medial 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. 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.

Paracolic gutters help keep infectious material away from the body s internal organs. When other peripancreatic collections expanded widely to paracolic. This patient was asymptomatic during the last follow up. Pfcs may also extend to left paracolic space.

Best practice advice 9. 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. Consecutive patients with symptomatic won extending into the retroperitoneum were included in a prospective registry.

The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly. When disruption of the pancreatic duct with leak was evident a pancreatic duct stent was placed using standard endoscopic techniques 25. Percutaneous drainage should be employed when endoscopic drainage is unavailable unsuccessful or not technically feasible. Recently endoscopic necrosectomy has become the mainstay for management.

Endoscopic therapy was combined with surgery because of necrosis extending into the paracolic gutter in patient 10. Fluid collections developing from body and tail of pancreas form in the lesser sac. Of necrotic collections that extend into the paracolic gutter. Two patients patients 8 and 12 developed recurrent pseudocysts after 2 and 4 months respectively.