Paracolic Gutter Pancreatitis

The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon.

Paracolic gutter pancreatitis.

Cleaning the paracolic gutter. The main paracolic gutter lies lateral to the colon on each side. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. There is a moderate volume of free intraabdominal fluid with pockets scattered through the mesentery and pooling in the paracolic gutters.

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. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically. The adjacent second and third segments of the duodenum demonstrate mural thickening in keeping with reactive change.

A less obvious medial paracolic gutter may be formed especially on the right side if the colon. Recently endoscopic necrosectomy has become the mainstay for management. The left medial paracolic gutter.