A patient presents with acute pancreatitis. The enzyme-rich fluid tracks along the transverse mesocolon, creating Grey Turner's sign (flank discolouration). Through which specific peritoneal pathway does peripancreatic fluid most directly reach the flanks via the paracolic gutters?

• A Fluid directly perforates through the transverse mesocolon into the right paracolic gutter
• B Fluid ascends via the falciform ligament to the right subphrenic space
• C Fluid from the lesser sac enters the greater sac through the epiploic foramen (of Winslow) and then tracks down the paracolic gutters ✓
• D Fluid passes through the hepatoduodenal ligament to reach Morrison's pouch first

Explanation

In acute pancreatitis, enzymes initially accumulate in the lesser sac (omental bursa) posterior to the stomach, because the pancreas lies retroperitoneally posterior to the lesser sac. The only communication between the lesser sac and the greater peritoneal cavity is the epiploic foramen (of Winslow). Once fluid exits through this foramen into the greater sac, it can track inferiorly down the paracolic gutters (right more freely than left, as the phrenicocolic ligament limits left-sided spread). This explains why the epigastric/flank Grey Turner's sign may develop. The transverse mesocolon itself acts as a barrier initially.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.