Paracolic gutters are open areas between the wall of the abdomen and the colon. These gutters are used to drain infectious material away from the essential internal organs. There are two paracolic gutters in the body, the right and left lateral paracolic gutter. This abdominal space may also be referred to as the paracolic recesses or the sulci paracolici, but is different from the paramesenteric gutters.
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. The right lateral gutter is much larger and allows for greater drainage than the left gutter. It runs along the right side of the abdominal cavity and begins at the ascending portion of the colon from the right hepatic flexure, or the point where the colon turns from the ascending colon to the transverse colon. This gutter then continues downward and ends below at the cecum and the terminal ileum, or the part where the ileum attaches to the cecum. The right paracolic gutter is continuous with the perisplenic space or area around the spleen.
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. This gutter is, however, much smaller because it is restricted at the top by the phrenicocolic ligament, or the ligament supporting the top left edge of the colon. The phrenicocolic ligament prevents the left gutter from being continuous with the perisplenic space.
Paracolic gutters function to drain fluid that leaks from the colon, such as infectious matter, pus or bile, and to prevent infection or damage to the outer margin of the colon. This drainage occurs in much the same way that the gutters on a house draw the rain off the roof. In the abdominal cavity, fluid leaches from the colon into either the left or the right lateral gutter and then drains down the gutter into the pelvic area. Drainage in patients lying down can be reversed with infectious material from an infected appendix, located near the cecum, running up the right paracolic gutter.
These gutters are sometimes confused with another set of recesses, called the left and right paramesenteric gutters, which together make up the four main open spaces in the abdomen. Paramesenteric gutters are located between the colon and the mesentery, which is the part of the peritoneum that supports the internal organs. The paramesenteric gutters also function to drain fluid away.
Paracolic Gutter Fluid
Paracolic gutter fluid is produced naturally when a patient is in the supine position. Laying down allows abdominal fluids to accumulate in the paracolic gutters due to gravity, whereas the upright position would usually route these fluids to the pelvic recesses. When paracolic fluid accumulates in excess, it sometimes requires surgical intervention in the form of drainage.
When functioning normally, however, paracolic fluid will eventually be routed throughout the abdomen and drained naturally. Fluid in a supine patient, for example, will likely be routed to the omental bursa — an abdominal cavity that can capture fluid from the stomach and other organs. This fluid should drain naturally, but if it does not, an abscess can be addressed via paracentesis.
Paracolic gutter fluid typically contains pus, bile, blood, and other bodily substances, but sometimes it contains infectious matter that can be harmful to a patient. In more severe cases, this may coincide with the development of ascites, causing an excess of abdominal fluid to build up.
Paracolic Gutter Anatomy
The paracolic gutters are often confused with other parts of the anatomy that are similar in function and location. The aforementioned paramesenteric gutters, for example, are peritoneal recesses located in the abdomen located between the mesentery and the colon. Paracolic gutters are located in close proximity, along the descending and ascending colons. The right and left paracolic gutters create a mirror image within the posterior abdominal wall.
The right paracolic gutter originates at the colon’s hepatic fixture and continues laterally along the ascending colon, near the caecum. It continues alongside the peritoneum and to the pelvic brim. This position facilitates the draining of paracolic gutter fluids into the pelvic cavity and omental bursa.
The left paracolic gutter is sometimes referred to as the “main paracolic gutter,” and it is positioned laterally along the descending colon. The phrenicocolic ligament limits its position and disrupts its anatomic continuity within the subphrenic space of the left side abdominal cavity.
Right Paracolic Gutter
The right paracolic gutter serves several important functions. It provides a wide space for the drainage of fluid, but it is notable for its small size in comparison to the left paracolic gutter. Interestingly, though, this does not minimize its capacity for fluid. Rather, it makes the right paracolic gutter less susceptible to subphrenic conditions such as abscesses, fatty masses, and interposition of the colon.
The right paracolic gutter is also integral in responding to an infected appendix. Infected fluids are typically routed to the hepatorenal recess via the right paracolic gutter. This allows fluid from the infection to be drained, although if it continues to collect, it may be surgically drained in order to prevent the development of an abscess.
It should be noted, too, that the right paracolic gutter is part of the abdomen’s inframesocolic space. This position allows it to gather additional fluid and facilitate more flow than the left paracolic gutter can accommodate. This is because it is positioned deeper in the abdominal cavity than the left gutter.
Parabolic gutter fluid, Parabolic gutter anatomy, Right parabolic gutter.