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.
Appendicitis fluid in paracolic gutter.
5 year old girl with a two day history of nausea vomiting fever and abdominal pain presented to the emergency room.
The patient presented with an elevated white blood cell count and right upper quadrant pain.
10 an inflamed appendix demonstrates restricted diffusion 10 the appendix may be filled with high t2 fluid or edema which decreases in signal intensity if the fluid is.
Fluid may sit within the peritoneal space or paracolic gutters or may be interposed between bowel loops or around solid organs e g.
These gutters are clinically important because they allow a channel for infectious fluid from different abdominal compartments.
Anterior segment arrow is partially compressed with flattened oval shape and normal diameter of 5 mm but posterior segment arrowhead is rounded with diameter of 7 mm.
Perforated appendicitis with free fluid.
Return to ultrasound findings.
Trace periappendiceal hypoechoic fluid is seen which is nonspecific and may relate to edema or trace dependent fluid in paracolic gutter.
Infected peritoneal fluids get a passageway through these gutters to other compartments of the abdominal cavity.
The presence of the gutters also puts the lesser sac at risk of abscission as infected fluids from pancreas and appendix formed due to pancreatitis and appendicitis respectively will accumulate in the left sac.
The findings may be similar to those seen in acute appendicitis including pericaecal inflammatory change abscess formation fluid in the right paracolic gutter cecal wall thickening and an ileocecal mass.
On mri the appearance of acute appendicitis includes an appendiceal diameter 7 mm and adjacent fat stranding that is often best appreciated on t2 fat saturated sequences.
Fluid on ct is relatively hypodense dark on ct.
It can be compared to fluid in the gallbladder or stomach.
Dense fluid may suggest hemoperitoneum especially in the context of trauma.
These gutters are clinically important because they allow a passage for infectious fluids from different compartments of the abdomen.
Surgical drains were placed in the pelvis and right paracolic gutter.
Fluid from an infected appendix can track up the right paracolic gutter to the hepatorenal recess.
