Paracolic Gutter Hematoma

Common sources of spontaneous abdominal hemorrhage are visceral hepatic splenic renal and adrenal gynecologic coagulopathy related and vascular.

Paracolic gutter hematoma.

The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end. Liver or splenic hemorrhage more typically descends peripherally along the paracolic gutters into the pelvis and is not entrapped in interloop spaces. The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. In a male patient this is a very uncommon diagnosis.

Thus centrally located triangular areas of high attenuation abdominal fluid should prompt a search for intraperitoneal bowel or mesenteric injury 7 8. The left medial paracolic gutter. The paracolic gutter is associated with a subphrenic abscess. Open in a separate window fig.

Urgent laparotomy revealed an extensive hemoperitoneum. The paracolic spaces gutters are located lateral to the peritoneal reflections of the left and right sides of the colon fig 8a. These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. 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.

Role of computed tomography in evaluation of ascites. There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen. Spontaneous liver haematoma as a result of thrombolytic therapy. The right paracolic gutter is larger than the left and communicates freely with the right subphrenic space.

The retroperitoneal hematoma measured 13 4 mm diameter and severely compressed the inferior vena cava ivc fig. Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity. Ipsilateral psoas hematoma and fat stranding in the right paracolic gutter confirmed rupture of the hemorrhagic cyst from the right native kidney fig. This is followed by accumulation of ascites in sub hepatic location in 86 cases 86 in morrison s pouch in 85 cases 85 in paracolic gutters in 78 cases 78 in pelvis in 64 cases 64.

The main paracolic gutter lies lateral to the colon on each side. Spontaneous abdominal hemorrhage is defined as the presence of intraabdominal hemorrhage from a nontraumatic and noniatrogenic cause. Postoperative computed tomography scan of the abdomen showing extensive hemoperitoneum below the spleen in the left paracolic gutter in front of urinary bladder measuring 12 cm in dimension and a distended rectum measuring 8 5 5.