Paracolic Gutter Cyst

In a male patient this is a very uncommon diagnosis.

Paracolic gutter cyst.

The paracolic gutter is associated with a subphrenic abscess. The main paracolic gutter lies lateral to the colon on each side. But disease history including appendicitis or mucous as coincidental finding are alternative forms of presentation. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity.

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. 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. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. 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.

These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. 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. Peritoneal septa and loculated perihepatic fluid may be seen and gallbladder wall thickening may also be depicted fig 14a 14b 40 41.