Pancreatic Drainage Into Paracolic Gutter

Endoscopic therapy was combined with surgery because of necrosis extending into the paracolic gutter in patient 10.

Pancreatic drainage into paracolic gutter.

Fluid collections developing from body and tail of pancreas form in the lesser sac. 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. Two patients patients 8 and 12 developed recurrent pseudocysts after 2 and 4 months respectively. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically.

The proximal tip of the pancreatic duct stent was advanced either well into the collection or bridged the site of pancreatic duct disruption. Both paracolic gutters run laterally along the back side of the abdominal wall and are situated between the abdominal wall and the outer margin of the colon. Self expanding metal stents in the form of lumen apposing. Paracolic gutters help keep infectious material away from the body s internal organs.

Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly. When other peripancreatic collections expanded widely to paracolic. Recently endoscopic necrosectomy has become the mainstay for management.

The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. The right lateral gutter is much larger and allows for greater drainage than the left gutter. Consecutive patients with symptomatic won extending into the retroperitoneum were included in a prospective registry. When disruption of the pancreatic duct with leak was evident a pancreatic duct stent was placed using standard endoscopic techniques 25.

These collections are in close proximity to posterior wall of the stomach and thus amenable for internal drainage into the stomach. Pfcs may also extend to left paracolic space. The main paracolic gutter lies lateral to the colon on each side. In a supine patient the peritoneal fluid tends to collect under the.

Of necrotic collections that extend into the paracolic gutter. 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.