Paracolic Gutter Cyst

Fluid and fat stranding can be seen extending from the pelvis into the right upper quadrant by way of the paracolic gutter.

Paracolic gutter cyst.

The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. However the phrenicocolic ligament which is a peritoneal fold extending from the splenic flexure of the colon to the diaphragm limits the spread of peritoneal processes in the left upper quadrant because it partially separates the perisplenic space from the left paracolic gutter 2. In a male patient this is a very uncommon diagnosis. The paracolic gutter is associated with a subphrenic abscess.

Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen. Peritoneal septa and loculated perihepatic fluid may be seen and gallbladder wall thickening may also be depicted fig 14a 14b 40 41. 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. These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. The main paracolic gutter lies lateral to the colon on each side.