Paracolic gutters

The paracolic gutters (paracolic sulci, paracolic recesses) are spaces between the colon and the abdominal wall.

Structure

There are two paracolic gutters:

The right lateral paracolic gutter.
The left medial paracolic gutter.

The right and left paracolic gutters are peritoneal recesses on the posterior abdominal wall lying alongside the ascending and descending colon. The main paracolic gutter lies lateral to the colon on each side. 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. 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 caecum. It is continuous with the peritoneum as it descends into the pelvis over the pelvic brim. Superiorly, it is continuous with the peritoneum which lines the hepatorenal pouch and, through the epiploic foramen, the lesser sac.^[1]

Variation

The right paracolic gutter is larger than the left, which together with the partial barrier provided by the phrenicocolic ligament, may explain why right subphrenic collections are more common than left subphrenic collections.^[2]

Function

These gutters are clinically important because they allow a passage for infectious fluids from different compartments of the abdomen. For example; fluid from an infected appendix can track up the right paracolic gutter to the hepatorenal recess.

Clinical significance

Bile, pus or blood released from viscera anywhere along its length may run along the gutter and collect in sites quite remote from the organ of origin. In supine patients, infected fluid from the right iliac fossa may ascend in the gutter to enter the lesser sac. In patients nursed in a sitting position, fluid from the stomach, duodenum or gallbladder may run down the gutter to collect in the right iliac fossa or pelvis and may mimic acute appendicitis or form a pelvic abscess. The right paracolic gutter is larger than the left, which together with the partial barrier provided by the phrenicocolic ligament, may explain why right subphrenic collections are more common than left subphrenic collections.^[3]

References

↑ Grays Anatomy 39th Edition. Page No. 1136
↑ Grays Anatomy 39th Edition. Page No. 1136
↑ Grays Anatomy 39th Edition. Page No. 1136

External links

Anatomy photo:37:14-0100 at the SUNY Downstate Medical Center - "Abdominal Cavity: Peritoneal Gutters"

Anatomy of the peritoneum and mesentery

General

Abdominal

From ventral mesentery	Lesser omentum Hepatoduodenal ligament Hepatogastric ligament Liver Coronary ligament (Left triangular ligament Right triangular ligament Hepatorenal ligament) Falciform ligament (Round ligament of liver and Ligamentum venosum in it, but not of it)

From dorsal mesentery	Greater omentum Gastrophrenic ligament Gastrocolic ligament Gastrosplenic ligament Mesentery Transverse mesocolon Sigmoid mesocolon Mesoappendix Root of the mesentery Splenorenal ligament Phrenicocolic ligament Folds Umbilical folds Supravesical fossa Medial inguinal fossa Lateral umbilical fold Lateral inguinal fossa Ileocecal fold

Abdominal cavity	Greater sac Lesser sac Omental foramen

General	Cystohepatic triangle Hepatorenal recess of subhepatic space Abdominal wall Inguinal triangle Peritoneal recesses Paracolic gutters Paramesenteric gutters

Pelvic

Uterus/ovaries	Broad ligament of the uterus Mesovarium Mesosalpinx Mesometrium) Ovarian ligament Suspensory ligament of ovary

Recesses	Male Recto-vesical pouch Pararectal fossa Female Recto-uterine pouch Recto-uterine fold (Uterosacral ligament) Vesico-uterine pouch Ovarian fossa Paravesical fossa Retroperitonium

Spaces

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