Paracolic Gutter Ascites

The right paracolic gutter is larger than the left and communicates freely with the right subphrenic space.

Paracolic gutter ascites.

In some disorders peritoneal fluid represents a complication or late manifestation of disease whereas in others it is the first clinical expression of the disease process. Larger amounts of fluid accumulate in paracolic gutters. The right lateral gutter is much larger and allows for greater drainage than the left gutter. Visualized pancreas shows dilated main pancreatic duct 4 5 mm.

Traditionally paracentesis was performed blindly using standard anatomical landmarks. The paracolic spaces gutters are located lateral to the peritoneal reflections of the left and right sides of the colon fig 8a. Computed tomography is particularly important for detailed preoperative assessment and evaluation of the radiological peritoneal cancer index. The main paracolic gutter lies lateral to the colon on each side.

Ascites is the pathologic accumulation of fluid in the peritoneal cavity. Based on how fluid travels in the abdomen the most likely place to find fluid is in the right upper quadrant and pelvis. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. Ultrasound gross amount of free fluid is noted in hepatorenal splenorenal perihepatic perisplenic both paracolic gutters both iliac fossa and pelvic.

Peritoneal carcinomatosis is intraperitoneal dissemination of any form of cancer that does not originate from the peritoneum itself. Paracolic gutters help keep infectious material away from the body s internal organs. Small amounts of ascites typically seen in right perihepatic space morison pouch and pouch of douglas. Various tumours and tumour like conditions can mimic p.

Ascites can cause centralization of bowel loops. Therefore some physicians favor the right paracolic gutter approach. The imaging findings vary from simple ascites to multifocal discrete nodules and infiltrative peritoneal masses. 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.

Unlike fluid seen in vessels or the bladder that have contained borders ascites fills potential spaces in the abdomen and pelvis. 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. Pc is most commonly seen in abdominopelvic malignancies. 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.

As the etiology of ascites in most patients is liver cirrhosis with associated portal hypertension the liver typically becomes smaller and the spleen larger as disease progresses. Hemoperitoneum starts near the site of injury and flows along expected anatomic pathways.