Paracolic Gutter Cyst

The right lateral paracolic gutter runs from the superiolateral aspect of the hepatic flexure of the colon down the lateral aspect of the ascending colon and around the cecum.

Paracolic gutter cyst.

Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. Peritoneal septa and loculated perihepatic fluid may be seen and gallbladder wall thickening may also be depicted fig 14a 14b 40 41. But disease history including appendicitis or mucous as coincidental finding are alternative forms of presentation. Symptoms of cancer spreading in the peritoneum the clinical profile of pseudomyxoma peritonei is normally increasing abdominal circumference and confirmation of mucous in the abdominal cavity jelly belly.

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. The paracolic gutter is associated with a subphrenic abscess. The main paracolic gutter lies lateral to the colon on each side. In a male patient this is a very uncommon diagnosis.

Fluid and fat stranding can be seen extending from the pelvis into the right upper quadrant by way of the paracolic gutter. However the phrenicocolic ligament which is a peritoneal fold extending from the splenic flexure of the colon to the diaphragm limits the spread of peritoneal processes in the left upper quadrant because it partially separates the perisplenic space from the left paracolic gutter 2. There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen.