Right Paracolic Gutter Cecum and Ascending Colon and Morisons Pouch Radiologic Features

Following the flow of ascitic fluid from the pelvis preferentially upward within the right paracolic gutter, deposition and growth in this peritoneal recess are shown by mass changes lateral and posterior to the cecum and proximal ascending colon (Figs. 4-141 through 4-144). Tethering of mucosal folds or angulated fixation of a small bowel loop in this area may occur as a consequence of an associated fibrous reaction (Fig. 4-145). This localization in the right paracolic gutter occurs in 18% of cases. More cephalad deposition in the right subhepatic space may occasionally be identified (Figs. 4-146 and 4-147).

Right Subhepatic Space

Fig. 4—130. Seeded pancreatic carcinoma along lower small bowel.

(a) Barium enema with (b) air-contrast studies demonstrate changes involving the cecum and terminal ileum closely simulating granulomatous enterocolitis. (Reproduced from Meyers. )

Fig. 4—130. Seeded pancreatic carcinoma along lower small bowel.

(a) Barium enema with (b) air-contrast studies demonstrate changes involving the cecum and terminal ileum closely simulating granulomatous enterocolitis. (Reproduced from Meyers. )

Ileum Carcinoma

Fig. 4—131. Diffuse seeded metastases from gastric carcinoma along small bowel mesentery.

Serosal masses are present predominantly on the mesenteric borders of small bowel loops, including the ileum in the right lower quadrant. The mucosal folds are tethered, and there are angulations and alternating constrictions of loops. These changes are consequent to the fibrotic reaction.

Bowel Contour Sigmoid Mesocolon

Fig. 4-132. The sigmoid mesocolon.

(a and b) CT identifies the fat-laden sigmoid mesocolon (SM) and its relationship to the sigmoid colon (SC), which in this case bears diverticula, and to sigmoid and superior rectal vessels (arrows).

Sigmoid Mesocolon

Fig. 4-132. The sigmoid mesocolon.

(a and b) CT identifies the fat-laden sigmoid mesocolon (SM) and its relationship to the sigmoid colon (SC), which in this case bears diverticula, and to sigmoid and superior rectal vessels (arrows).

Sigmoid Mesocolon

Fig. 4-133. Seeding in the sigmoid mesocolon from colonic carcinoma.

Metastatic mass impresses the superior contour of the sigmoid colon.

Fig. 4-133. Seeding in the sigmoid mesocolon from colonic carcinoma.

Metastatic mass impresses the superior contour of the sigmoid colon.

Morisons Pouch

Fig. 4-134. Seeding on the sigmoid mesocolon from pancreatic carcinoma.

CT identifies metastatic deposits (arrows) on the fatty sigmoid mesocolon. Massive ascites is present.

Fig. 4-134. Seeding on the sigmoid mesocolon from pancreatic carcinoma.

CT identifies metastatic deposits (arrows) on the fatty sigmoid mesocolon. Massive ascites is present.

Sigmoid Mesocolon

Fig. 4-135. Calcified seeded metastases on the sigmoid mesocolon.

Calcified deposits (arrows) from a serous cystadenocarcinoma of the ovary have lodged on the mesocolon adjacent to the sigmoid colon (S). (Courtesy ofMichiel Feldberg, M.D., Ph.D., University of Utrecht, The Netherlands.)

Fig. 4-135. Calcified seeded metastases on the sigmoid mesocolon.

Calcified deposits (arrows) from a serous cystadenocarcinoma of the ovary have lodged on the mesocolon adjacent to the sigmoid colon (S). (Courtesy ofMichiel Feldberg, M.D., Ph.D., University of Utrecht, The Netherlands.)

Calcific Deposits Suprapatellar Pouch

Fig. 4-136. Intraperitoneal seeding in the sigmoid mesocolon from pancreatic carcinoma.

The desmoplastic reaction accompanying the deposits causes tethering of the mucosal folds along the superior border of the sigmoid colon, angulated (arrows) toward a common site in the mesentery. (Reproduced from Meyers. )

Fig. 4-136. Intraperitoneal seeding in the sigmoid mesocolon from pancreatic carcinoma.

The desmoplastic reaction accompanying the deposits causes tethering of the mucosal folds along the superior border of the sigmoid colon, angulated (arrows) toward a common site in the mesentery. (Reproduced from Meyers. )

Fig. 4-137. Intraperitoneal seeding in the sigmoid mesocolon from gastric carcinoma.

The desmoplastic response tethers mucosal folds along the superior border of the sigmoid colon (arrows). (Reproduced from Maruyama M: Radiologic Diagnosis of Polyps and Carcinoma of the Large Bowel. Igaku-Shoin, Tokyo, 1977.)

Fig. 4-137. Intraperitoneal seeding in the sigmoid mesocolon from gastric carcinoma.

The desmoplastic response tethers mucosal folds along the superior border of the sigmoid colon (arrows). (Reproduced from Maruyama M: Radiologic Diagnosis of Polyps and Carcinoma of the Large Bowel. Igaku-Shoin, Tokyo, 1977.)

Fig. 4-138. Metastatic seeding in sigmoid mesocolon.

The superior margin of the sigmoid colon is involved over a considerable length with infiltra-tive and desmoplastic mucosal changes (arrow line). Mucosal elevation seen en face suggests sub-mucosal tumor (arrow). (Reproduced from Maruyama M: Radiologic Diagnosis of Polyps and Carcinoma of the Large Bowel. Igaku-Shoin, Tokyo, 1977.)

Black And White Asian Art
Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Responses

  • Thomas
    What causes angulated colon?
    6 years ago
  • amaranth goold
    What is tethered colon?
    4 years ago

Post a comment