Paracolic Gutter Cyst

The main paracolic gutter lies lateral to the colon on each side.

Paracolic gutter cyst.

Fluid and fat stranding can be seen extending from the pelvis into the right upper quadrant by way of the paracolic gutter. The paracolic gutter is associated with a subphrenic abscess. 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 cecum.

In a male patient this is a very uncommon diagnosis. These images look quite similar to images of a pseudomyxoma peritonei which was discussed before. In the clinical setting of primary and secondary. However the phrenicocolic ligament which is a peritoneal fold extending from the splenic flexure of the colon to the diaphragm limits the spread of peritoneal processes in the left upper quadrant because it partially separates the perisplenic space from the left paracolic gutter 2.

But disease history including appendicitis or mucous as coincidental finding are alternative forms of presentation. There is a multi cystic mass extending from the pelvis along the right paracolic gutter to the upper abdomen. The right and left paracolic gutter are connected to subphrenic spaces proximally and to the pelvic area at the distal end.