Paracolic Gutter Pancreatitis

There is a moderate volume of free intraabdominal fluid with pockets scattered through the mesentery and pooling in the paracolic gutters. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically.

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Pancreatic Injury Post Laparoscopic Subtotal Colectomy There Is Pancreatic Fluid Tracking From The Pancreatic Tail Arrows To Th Colectomy Abdomen Pancreatic

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The main paracolic gutter lies lateral to the colon on each side.

Paracolic gutter pancreatitis.

There is moderate and diffuse peripancreatic fat stranding. Recently endoscopic necrosectomy has become the mainstay for management. The left medial paracolic gutter. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end.

The adjacent second and third segments of the duodenum demonstrate mural thickening in keeping with reactive change. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. The paracolic gutter is associated with a subphrenic abscess.

Transcutaneous endoscopic necrosectomy through a fully covered metal esophageal stent transgastric endoscopic necrosectomy with nasocystic lavage is accepted as one of the standards of care for the management of walled off necrosis secondary to acute pancreatitis. A less obvious medial paracolic gutter may be formed especially on the right side if the colon. Cleaning the paracolic gutter.

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