Paracolic Gutter Pancreatitis

Recently endoscopic necrosectomy has become the mainstay for management.

Paracolic gutter pancreatitis. Transcutaneous endoscopic necrosectomy through a fully covered metal esophageal stent transgastric endoscopic necrosectomy with nasocystic lavage is accepted as one of the standards of care for the management of walled off necrosis secondary to acute pancreatitis. There is moderate and diffuse peripancreatic fat stranding. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. The main paracolic gutter lies lateral to the colon on each side.

The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically.

The left medial paracolic gutter. The paracolic gutter is associated with a subphrenic abscess. The adjacent second and third segments of the duodenum demonstrate mural thickening in keeping with reactive change.