From the Guidelines
The right gutter of the abdomen, also known as the right paracolic gutter, is a critical anatomical space that requires careful evaluation in patients with abdominal pain or suspected intra-abdominal pathology, as it can collect purulent material and serve as a pathway for fluid drainage within the peritoneal cavity 1.
Key Points to Consider
- The right paracolic gutter is located between the right side of the colon and the lateral abdominal wall, and its anatomy is essential for proper interpretation of abdominal imaging 1.
- Fluids, including blood, pus, or ascites, can travel through this gutter from the upper abdomen down to the pelvis due to gravity when a patient is in an upright position 1.
- During abdominal infections or inflammation, such as appendicitis, the right paracolic gutter often collects purulent material, which can be detected on imaging studies like CT scans 1.
- Understanding the right gutter's anatomy is crucial for planning surgical approaches to address collections of fluid or infection in this region, and source control is a critical aspect of managing intra-abdominal infections 1.
Diagnostic and Therapeutic Approaches
- Ultrasound and CT-guided percutaneous drainage of abdominal and extraperitoneal abscesses are safe and effective in selected patients 1.
- Surgical source control, including resection or suture of a diseased or perforated viscus, removal of the infected organ, debridement of necrotic tissue, and repair/resection of traumatic perforations, may be necessary in some cases 1.
- Laparoscopy has been gaining wider acceptance in the diagnosis and treatment of intra-abdominal infections, but its use may be limited in resource-poor countries due to cost and availability of equipment 1.
Clinical Implications
- A high index of suspicion is mandatory when evaluating patients with abdominal pain or suspected intra-abdominal pathology, particularly in immunocompromised patients or those with a history of cancer or chemotherapy 1.
- Prompt and accurate diagnosis, as well as effective source control and antibiotic therapy, are critical to reducing morbidity and mortality in patients with intra-abdominal infections 1.
From the Research
Right Gutter of the Abdomen
The right gutter of the abdomen is a passageway for fluids between the upper and lower compartments of the peritoneal cavity.
- The right paracolic gutter is the main passageway for fluids due to the phrenicocolic ligament, which acts as a barrier to the advancing of fluids along the left paracolic gutter 2.
- This anatomical structure explains why abscesses are more frequent in the right than in the upper left abdominal regions 2.
- The peritoneal fluid can be visualized by US when it contains fluid, allowing for a clear visualization of the anatomy of various peritoneal structures in either upper or lower areas 2.
Abscesses in the Abdomen
Abscesses in the abdomen can be treated with CT-guided percutaneous drainage, which is an established method for the treatment of abdominal abscesses 3.
- The effectiveness and safety of drainage of abdominal abscesses with small-bore drains have been evaluated in a single-centre observational study, showing a high technical and clinical success rate 3.
- CT-guided drainage of abdominal abscesses with small- and very small-bore drains is usually sufficient to obtain clinical success with a low complication rate in the case of thick fluid collections 3.
- The treatment of deep intramuscular and musculoskeletal abscesses with CT-guided percutaneous catheter drainage has also been described, with a high success rate in draining collections involving muscle alone, but a higher risk of drain failure in cases with skeletal infection 4.