Contrast enhanced axial ct scan shows loops of small bowel arrow posterior and lateral to cecum asterisk in right paracolic gutter producing small bowel obstruction.
Right paracolic gutter ct.
Figure 110 2 common pathways of intraperitoneal fluid spread.
In a male patient this is a very uncommon diagnosis.
Courtesy of ghahremani gg san diego ca view larger version 103k.
The right lateral paracolic gutter runs from the superolateral aspect of the hepatic flexure of the colon down the lateral aspect of the ascending colon and around the caecum.
The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon.
The right lateral paracolic gutter runs along the right side of the cavity of the abdomen.
This is discussed more fully in chapter 108.
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 ascending colon a is displaced anteriorly and ascites arrowhead is seen in the right paracolic gutter.
The inframesocolic space also contains paracolic gutters which are peritoneal recesses that are inferolateral extensions of their corresponding inframesocolic spaces on the posterior abdominal wall lateral to the ascending and descending colon respectively.
Ct these hernias can often be confidently diagnosed as a cluster of bowel loops usually ileal located posteriorly and laterally to the normal cecum occasionally extending into the right paracolic gutter.
The right paracolic gutter is larger than the left and communicates freely with the right subphrenic space.
Fluid in the right paracolic gutter which structure represents the main communication between the upper and lower abdominal compartments reaches morison s pouch and subsequently the right subphrenic space.
B ct scan of the pelvis shows that the bowel loops of the oral aspect of the intestine are dilated arrowhead and the bowel loops of the anal aspect are collapsed arrow.
The connection between the left paracolic gutter and the left subphrenic space is partially limited by the phrenicocolic ligament.
The main paracolic gutter lies lateral to the colon on each side.
There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen.
Laparotomy was performed 6 hours after ct.
