Pancreatic Drainage Into Paracolic Gutter

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.

Pancreatic drainage into paracolic gutter.

Walled off pancreatic necrosis won is a sequelae of acute pancreatitis that requires debridement once infected. Paracolic gutters help keep infectious material away from the body s internal organs. Pfcs may also extend to left paracolic space. Two patients patients 8 and 12 developed recurrent pseudocysts after 2 and 4 months respectively.

The left medial paracolic gutter. Consecutive patients with symptomatic won extending into the retroperitoneum were included in a prospective registry. The main paracolic gutter lies lateral to the colon on each side. Fluid collections developing from body and tail of pancreas form in the lesser sac.

The right lateral gutter is much larger and allows for greater drainage than the left gutter. When other peripancreatic collections expanded widely to paracolic. Endoscopic therapy was combined with surgery because of necrosis extending into the paracolic gutter in patient 10. In a supine patient the peritoneal fluid tends to collect under the.

When disruption of the pancreatic duct with leak was evident a pancreatic duct stent was placed using standard endoscopic techniques 25. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly. Self expanding metal stents in the form of lumen apposing.

Percutaneous drainage should be employed when endoscopic drainage is unavailable unsuccessful or not technically feasible. However peripancreatic collections that extend to the paracolic gutter or lesser sac are more challenging to treat endoscopically. Recently endoscopic necrosectomy has become the mainstay for management. A less obvious medial paracolic gutter may be formed especially on the right side if the colon.

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. The proximal tip of the pancreatic duct stent was advanced either well into the collection or bridged the site of pancreatic duct disruption. This patient was asymptomatic during the last follow up. These collections are in close proximity to posterior wall of the stomach and thus amenable for internal drainage into the stomach.