Left Paracolic Gutter

sulcus paracolicus sinister

The left paracolic gutter is the peritoneal recess between the lateral border of the descending colon and the left lateral abdominal wall. It is narrower than the right gutter and is partially obstructed by the phrenicocolic ligament superiorly, which limits direct communication with the left subphrenic space. It drains predominantly into the left iliac fossa and pelvis.

Region: Abdomen

Clinical Relevance

Clinical Notes

The phrenicocolic ligament at the superior end of the left paracolic gutter partially restricts fluid from tracking directly to the left subphrenic space, unlike the right gutter. Sigmoid diverticulitis collections and left colonic perforation produce pus in the left paracolic gutter. In laparoscopic left colectomy and sigmoid resection, the left paracolic gutter dissection mobilises the descending colon by incising the white line of Toldt lateral to the gutter. Peritoneal fluid in the left gutter on FAST may indicate spenic injury or left colon perforation.

Pathology

Common Injuries & Conditions

Left Paracolic Gutter Collection in Sigmoid Diverticulitis

Contained sigmoid diverticular perforation produces a pericolic abscess in the left paracolic gutter that may track inferomedially to the pelvis; CT demonstrates the collection adjacent to the sigmoid, managed by antibiotics for small collections and CT-guided drainage for abscesses larger than 3-4 cm.