Paracolic Gutter Hematoma

Role of computed tomography in evaluation of ascites.

Paracolic gutter hematoma.

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. The paracolic gutter is associated with a subphrenic abscess. These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. This is followed by accumulation of ascites in sub hepatic location in 86 cases 86 in morrison s pouch in 85 cases 85 in paracolic gutters in 78 cases 78 in pelvis in 64 cases 64.

The retroperitoneal hematoma measured 13 4 mm diameter and severely compressed the inferior vena cava ivc fig. Open in a separate window fig. The right lateral gutter is much larger and allows for greater drainage than the left gutter. Ipsilateral psoas hematoma and fat stranding in the right paracolic gutter confirmed rupture of the hemorrhagic cyst from the right native kidney fig.

The right paracolic gutter is larger than the left and communicates freely with the right subphrenic space. Spontaneous abdominal hemorrhage is defined as the presence of intraabdominal hemorrhage from a nontraumatic and noniatrogenic cause. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. Urgent laparotomy revealed an extensive hemoperitoneum.

Paracolic gutters help keep infectious material away from the body s internal organs. The paracolic spaces gutters are located lateral to the peritoneal reflections of the left and right sides of the colon fig 8a. A less obvious medial paracolic gutter may be formed especially on the right side if the colon. The left medial paracolic gutter.

Thus centrally located triangular areas of high attenuation abdominal fluid should prompt a search for intraperitoneal bowel or mesenteric injury 7 8. Common sources of spontaneous abdominal hemorrhage are visceral hepatic splenic renal and adrenal gynecologic coagulopathy related and vascular. Spontaneous liver haematoma as a result of thrombolytic therapy. The main paracolic gutter lies lateral to the colon on each side.

In a male patient this is a very uncommon diagnosis. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. Liver or splenic hemorrhage more typically descends peripherally along the paracolic gutters into the pelvis and is not entrapped in interloop spaces.