Pancreatic Drainage Into Paracolic Gutter

When disruption of the pancreatic duct with leak was evident a pancreatic duct stent was placed using standard endoscopic techniques 25.

Pancreatic drainage into paracolic gutter.

In a supine patient the peritoneal fluid tends to collect under the. Fluid collections developing from body and tail of pancreas form in the lesser sac. The left medial paracolic gutter. Consecutive patients with symptomatic won extending into the retroperitoneum were included in a prospective registry.

The proximal tip of the pancreatic duct stent was advanced either well into the collection or bridged the site of pancreatic duct disruption. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. When other peripancreatic collections expanded widely to paracolic. Percutaneous drainage should be employed when endoscopic drainage is unavailable unsuccessful or not technically feasible.

These collections are in close proximity to posterior wall of the stomach and thus amenable for internal drainage into the stomach. Strongly considered as an adjunct to endoscopic drainage for won with deep extension into the paracolic gutters and pelvis or for salvage therapy after endoscopic or surgical debridement with residual necrosis burden. Best practice advice 9. This patient was asymptomatic during the last follow up.

A less obvious medial paracolic gutter may be formed especially on the right side if the colon. The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly. Endoscopic therapy was combined with surgery because of necrosis extending into the paracolic gutter in patient 10. 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. Paracolic gutters help keep infectious material away from the body s internal organs. Recently endoscopic necrosectomy has become the mainstay for management. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically.

The right lateral gutter is much larger and allows for greater drainage than the left gutter. Two patients patients 8 and 12 developed recurrent pseudocysts after 2 and 4 months respectively. In cases where necrosis extends into one or both paracolic gutters and or into the pelvis the dependent portions of the collection will not be able to drain effectively through superiorly located transmural endoscopic. Pfcs may also extend to left paracolic space.