Right Paracolic Gutter Ultrasound

Visualize the left subdiaphragmatic space the most important area in the left upper quadrant splenorenal space and left paracolic gutter.

Right paracolic gutter ultrasound.

B left upper quadrant window. This is discussed more fully in chapter 108. Fluid may sit within the peritoneal space or paracolic gutters or may be interposed between bowel loops or around solid organs e g. The left gutter runs between the descending colon and the abdominal wall and just like the right gutter empties into the lower abdomen and pelvic area.

Fluid in the right paracolic gutter which structure represents the main communication between the upper and lower abdominal compartments reaches morison s pouch and subsequently the right subphrenic space. Abdominal case of the week cardiac ivc miscellaneous highlights procedure highlights lung ob gyn trauma soft tissue vascular msk. Therefore others refer to the left lower quadrant llq as the typical puncture point. Visualize the right subdiaphragmatic space hepatorenal recess morison pouch the most sensitive recess for upper abdominal free fluid and the right paracolic gutter.

Ultrasound is variably sensitive depending on the size of the patient and the operator. Therefore some physicians favor the right paracolic gutter approach. In this section ultrasound ultrasound education faculty image of the fortnight toggle section. The right paracolic gutter is continuous with the perisplenic space or area around the spleen.

The right lateral paracolic gutter. However the patient with ascites may have atypical anatomy due to varying dimensions of the spleen and liver in different pathology states. Figure 110 2 common pathways of intraperitoneal fluid spread. The left medial paracolic gutter.

Peritoneal septa and loculated perihepatic fluid may be seen and gallbladder wall thickening may also be depicted fig 14a 14b 40 41. Paracolic gutters refer to open areas between the wall of the abdomen and the colon. 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. Fluid and fat stranding can be seen extending from the pelvis into the right upper quadrant by way of the paracolic gutter.