Paracolic Gutter Pancreatitis

The adjacent second and third segments of the duodenum demonstrate mural thickening in keeping with reactive change.

Paracolic gutter pancreatitis.

Recently endoscopic necrosectomy has become the mainstay for management. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. The main paracolic gutter lies lateral to the colon on each side. A less obvious medial paracolic gutter may be formed especially on the right side if the colon.

Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically. The left medial paracolic gutter. Cleaning the paracolic gutter.

There is a moderate volume of free intraabdominal fluid with pockets scattered through the mesentery and pooling in the paracolic gutters. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected.