Gastroenterology

Gastroenterology

Volume 114, Issue 1, January 1998, Pages 185-196
Gastroenterology

Special Reports and Reviews
The pathobiology of peritonitis

https://doi.org/10.1016/S0016-5085(98)70646-8Get rights and content

Abstract

The peritoneum is more than a mechanical covering that allows for the easy gliding of opposed peritoneal surfaces. The peritoneal mesothelial cells facilitate the action of powerful innate immune mechanisms. In addition, the peritoneal-associated lymphoid tissues contain unique cells that may play a crucial role in the localization of intraperitoneal infection. A clearer understanding of the molecular and cellular events underlying peritoneal functions in both the unstimulated and stimulated state will aid future treatment of peritonitis.

GASTROENTEROLOGY 1998;114:185-196

Section snippets

The peritoneal cavity

The peritoneal mesothelium consists of a simple layer of polyhedral-shaped squamous cells that are about 3 μm thick. These cells contain a well-developed cytoskeleton of intermediate filaments, an abundant endoplasmic reticulum and Golgi apparatus, as well as numerous smooth-surfaced and coated vesicles indicative of active transmembrane transport.1, 2, 3

The PMCs contain mechanisms that allow for the easy gliding of opposed peritoneal surfaces. Like type 2 pneumocytes, PMCs contain

The omentum

Galen (128-199 AD) thought that the role of the omentum was to warm the intestines. This was on the basis of a gladiator who had an omental resection after a stab injury and suffered greatly from cold for the rest of his life.30 A more conventional view of the omentum is that it plays a central role in peritoneal defense by adhering to sites of inflammation.

Peritoneal defense systems

Janeway44 has commented on the superiority of innate (nonclonal) immune responses in the evolution of host defenses. This is certainly true within the peritoneal cavity. For example, coelomocytes in the peritoneal cavity of the common Atlantic starfish (Asterias forbesi) secrete an interleukin (IL)-1-like protein.45

Peritonitis

The peritoneal cavity deals with infection in three ways: first, a rapid absorption of bacteria via the diaphragmatic stomata; second, the destruction of bacteria via mechanisms generated by the complement cascade and phagocytes; and third, the localization of infection as an abscess. It is the complexities of the second phase that now hold our attention. Histamine and prostaglandins are released by mast cells and macrophages. This leads to vasodilatation and increased permeability of the

Conclusion

The peritoneum has evolved powerful innate and adaptive immune mechanisms. The first line of defense involves the clearance of noxious insults from the peritoneal cavity via lymphatics related to the parietal peritoneum, diaphragmatic stomata, and omentum. This is accompanied by activation of the complement cascade and, within a matter of hours, an up-regulation of peritoneal mesothelial cell activity, as well as an invasion of PMNs and macrophages. Once this occurs, there is intense combat

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    Address requests for reprints to: John C. Hall, F.R.A.C.S., University Department of Surgery, Royal Perth Hospital, Perth, Western Australia 6000, Australia. Fax: (61) 8-9224-0204.

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