Paracolic Gutter Cysts

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.

Paracolic gutter cysts.

Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. Pancreas can show acute inflammation suppuration hemorrhage and or extensive necrosis.

The paracolic gutter is associated with a subphrenic abscess. The retroperitoneal hematoma measured 13 4 mm diameter and severely compressed the inferior vena cava ivc fig. The main paracolic gutter lies lateral to the colon on each side. Ipsilateral psoas hematoma and fat stranding in the right paracolic gutter confirmed rupture of the hemorrhagic cyst from the right native kidney fig.

Download high res image 159kb. 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. Both the right and left paracolic gutters communicate with the pelvic spaces. 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.

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. But disease history including appendicitis or mucous as coincidental finding are alternative forms of presentation. Fluid can accumulate in lesser sac and pleural space and paracolic gutters. The connection between the left paracolic gutter and the left subphrenic space is partially limited by the phrenicocolic ligament.

Hemoperitoneum starts near the site of injury and flows along expected anatomic pathways. The inframesocolic space is the peritoneal space below the root of the transverse mesocolon the supramesocolic space lies above the transverse mesocolon s root. In a male patient this is a very uncommon diagnosis. Neutrophils infiltrate the edge of the necrotic areas and extend into the adjacent lobules of fat and produce fat necrosis.

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. There can be extensive peripancreatic inflammation. In men the most gravity dependent site for fluid accumulation is the rectovesical space.