Additional areas of involvement included Gerota's fascia on the left and the paracolic gutters
FAST usually includes US of the right upper quadrant, including the hepatorenal fossa, the left upper quadrant, including the perisplenic region; the right and left paracolic gutters, and the pelvis, performed to detect free fluid.
Regarding the sites, 16/29 patients showed fluid in the pelvis and rest in the perihepatic, perisplenic, right paracolic gutter and perinephric spaces.
The ultra sound revealed free fluid in sub hepatic space and right paracolic gutters
. In the pelvis a complex right adnexal mass measuring 5.7 x 6 cm with suspicion of hematoma was noted.
(4) Intraperitoneal spread is favored by intestinal peristalsis, negative hydrostatic pressure below the diaphragm, and the passage of exfoliated tumor cells that follow the intra-abdominal fluid stream passing along the paracolic gutters
toward the diaphragm.
They were then moved cranially to the ipsilateral paracolic gutters, just below the iliac crests, through retroperitoneal tunnels.
In the case of cervical cancer, the ovaries are moved to the paracolic gutters. The ovary may be pediculised on its own in order to limit the risk of malignancy to a maximum but this must be weighed against potential failure of the technique and therefore early menopause due to lack of vascularisation of the transposed ovary.
Perform four quadrant cell washings; inspect the small and large bowel; do a generous omental biopsy and an appendectomy for mucinous BOTs; perform random biopsies or Pap smear tests of the pelvic side walls, right hemidiaphragm, and the paracolic gutters
; submit all adhesions to pathology; palpate the paraaortic and pelvic nodes; and, finally, do a bilateral salpingo-oophorectomy and a total abdominal hysterectomy, except in those patients who are younger and want to preserve their fertility.
There was also severe bleeding from the perisplenic area, lesser sac, both the paracolic gutters
. After opening the lesser sac, bleeding was seen from the body of the pancreas and superior mesenteric artery, with enlarged spleen, dilated splenic and pancreatic vessels.
1), free fluid in the right and left subphrenic spaces tracking down both paracolic gutters
into the pelvis.
This is followed by accumulation of ascites in Sub hepatic location in 86 cases (86%), in Morrison's Pouch in 85 cases (85%), in Paracolic gutters
in 78 cases (78%) in Pelvis in 64 cases (64%).
Liver, spleen, undersurface of diaphragm, paracolic gutters
, omentum, paraaortic region and pouch of douglas were visualized and explored to see any metastatic deposits all were found free of any metastasis.