Special Reports and ReviewsThe pathobiology of peritonitis☆
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
References (126)
Observations on the peritoneum as an absorbing surface
Am J Obstet Gynecol
(1962)- et al.
Effect of PEEP on the rate of thoracic duct lymph flow and clearance of bacteria from the peritoneal cavity
Am J Surg
(1983) - et al.
Bacterial clearance and granulocyte response in experimental peritonitis
J Surg Res
(1986) - et al.
The biology of peritonitis and implications for treatment
Surg Clin North Am
(1988) - et al.
Milky spots in the mouse omentum may play an important role in the origin of peritoneal macrophages
Res Immunol
(1992) - et al.
An ultrastructural study of dopamine-immunoreactive nerve fibres in milky spots of the human greater omentum
Neurosci Lett
(1994) The immune system evolved to discriminate infectious nonself from noninfectious self
Immunol Today
(1992)- et al.
Complement in human diseases: looking towards the 21st century
Immunol Today
(1995) - et al.
Kinetics of changes in peritoneal cell populations following acute inflammation
Cell Immunol
(1989) - et al.
The interaction between mast cells and nerves in the gastrointestinal tract
Immunol Today
(1994)
Differential release of histamine and prostaglandin D2 in rat peritoneal mast cells: roles of cytosolic calcium and protein tyrosine kinases
Biochim Biophys Acta
Mucosal T cells and mast cells share common adhesion receptors
Immunol Today
Are omental milky spots an intestinal thymus?
Lancet
Involvement of B-1 cells in mucosal immunity and autoimmunity
Immunol Today
Normal human immune peritoneal cells: phenotypic characteristics
Immunobiology
Modulation of post-surgical macrophage function by early post-surgical polymorphonuclear leukocytes
J Surg Res
The production of cytokines by polymorpho-nuclear neutrophils
Immunol Today
Interaction of murine peritoneal leukocytes and mesothelial cells: in vitro model system to survey cellular events on serosal membranes during inflammation
Clin Immunol Immunopathol
Macrophage activation revisited
Immunol Today
Chemoattractant and opsonic activity in ascitic fluid: a study in 47 patients with cirrhosis or malignant ascites
J Hepatol
Recruitment of alloreactive natural killer cells to the rat peritoneum by a transfected cell line secreting rat recombinant interleukin-2
J Immunol Meth
Tissue tumor necrosis factor mRNA expression following cecal ligation and puncture or intraperitoneal injection of endotoxin
J Surg Res
Lymphocyte-derived cytokines augment macrophage tumor necrosis factor-alpha and interleukin-6 secretion during experimental gram-negative bacterial sepsis
J Surg Res
Human peritoneal mesothelial cell prostaglandin synthesis: induction of cyclooxygenase mRNA by peritoneal macrophage-derived cytokines
Kidney Int
Peritoneal fibrinolytic activity and intra-abdominal adhesions
Lancet
Enhancement of peritoneal macrophages reduces postoperative peritoneal adhesion formation
J Surg Res
Dose dependency and wound healing aspects of the use of tissue plasminogen activator in the prevention of intra-abdominal adhesions
Am J Surg
The ultrastructure of human abdominal mesothelium
J Anat
The mesothelium and its reactions: a review
Crit Rev Toxicol
A cobblestone cell isolated from the human omentum: the mesothelial cell; isolation, identification, and growth characteristics
In Vitro Cell Dev Biol
Synthesis of phospholipids by human peritoneal mesothelial cells
Perit Dial Int
Lymphatic stomata in the murine diaphragmatic peritoneum: the timing of their appearance and a map of their distribution
Anat Rec
Close similarity between cultured human omental mesothelial cells and endothelial cells in cytochemical markers and plasminogen activator production
In Vitro Cell Dev Biol
The tissues of the body: an introduction to the study of anatomy
The vascular endothelium: a new horizon
Ann Surg
Endothelins
N Engl J Med
A scanning electron microscopy morphometric study of the rabbit peritoneal surface
Anat Rec
Altered permeability of the peritoneal membrane after using hypertonic peritoneal dialysis fluid
J Clin Invest
Source of peritoneal proteoglycans. Human peritoneal mesothelial cells synthesize and secrete mainly small dermatan sulfate proteoglycans
Am J Pathol
Anionic fixed charges in the fenestrated capillaries of the mouse mesentery
Nephron
Zur fettresorption
Virchows Arch Pathol Anat Physiol
The role of the diaphragm in lymphatic absorption from the peritoneal cavity
J Anat
A scanning electron microscopic study on three-dimensional organization of human diaphragmatic lymphatics
Funct Dev Morphol
Peritoneal lymphatic uptake of fibrinogen and erythrocytes in the rat
Am J Physiol
Lymphatic absorption from the peritoneal cavity: regulation of patency of mesothelial stomata
Microvasc Res
Reactions of, and absorption by, lymphatics, with special reference to those of the diaphragm
Br J Exp Pathol
Infections of the peritoneum
Diffuse septic peritonitis, with special reference to a new method of treatment, namely, the elevated head and trunk posture, to facilitate drainage into the pelvis: with a report of nine consecutive cases of recovery
Med Rec
The spread of intraperitoneal infection
Acta Chir Scand
The spread and localization of acute intraperitoneal effusions
Radiology
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2022, International Review of Cell and Molecular BiologyRole of adipose-associated lymphoid tissues in the immunological homeostasis of the serosal surface
2020, Immunology LettersCitation Excerpt :In the following section, we will overview the structural and functional characteristics of abdominal adipose lymphoid tissues. Due to its capacity to sequester abdominal inflammation, the omentum has traditionally been described (mainly by surgeons) as a policeman of the peritoneal cavity. [24]. The omental leukocyte clusters are termed milky spots (MSs) [25] which structures function as peritoneal exit ports for blood-borne leukocytes [9].
Omentum a powerful biological source in regenerative surgery
2019, Regenerative Therapy
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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.