Pancreatic Drainage Into Paracolic Gutter

These collections are in close proximity to posterior wall of the stomach and thus amenable for internal drainage into the stomach.

Pancreatic drainage into paracolic gutter.

When other peripancreatic collections expanded widely to paracolic. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. Of necrotic collections that extend into the paracolic gutter. The right lateral gutter is much larger and allows for greater drainage than the left gutter.

The left medial paracolic gutter. The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly. The main paracolic gutter lies lateral to the colon on each side. Self expanding metal stents in the form of lumen apposing.

Endoscopic therapy was combined with surgery because of necrosis extending into the paracolic gutter in patient 10. 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. Best practice advice 9. This patient was asymptomatic during the last follow up.

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. Fluid collections developing from body and tail of pancreas form in the lesser sac. Consecutive patients with symptomatic won extending into the retroperitoneum were included in a prospective registry. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically.

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. Percutaneous drainage should be employed when endoscopic drainage is unavailable unsuccessful or not technically feasible. In a supine patient the peritoneal fluid tends to collect under the. Pfcs may also extend to left paracolic space.

A less obvious medial paracolic gutter may be formed especially on the right side if the colon. 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. When disruption of the pancreatic duct with leak was evident a pancreatic duct stent was placed using standard endoscopic techniques 25.