Functional vascular anatomy of the peritoneum in health and disease

Abstract

Abstract:The peritoneum consists of a layer of mesothelial cells on a connective tissue base which is perfused with circulatory and lymphatic vessels. Total effective blood flow to the human peritoneum is estimated between 60 and 100 mL/min, representing 1-2 % of the cardiac outflow. The parietal peritoneum accounts for about 30 % of the peritoneal surface (anterior abdominal wall 4 %) and is vascularized from the circumflex, iliac, lumbar, intercostal, and epigastric arteries, giving rise to a quadrangular network of large, parallel blood vessels and their perpendicular offshoots. Parietal vessels drain into the inferior vena cava. The visceral peritoneum accounts for 70 % of the peritoneal surface and derives its blood supply from the three major arteries that supply the splanchnic organs, celiac and superior and inferior mesenteric. These vessels give rise to smaller arteries that anastomose extensively. The visceral peritoneum drains into the portal vein. Drugs absorbed are subject to firstpass hepatic metabolism. Peritoneal inflammation and cancer invasion induce neoangiogenesis, leading to the development of an important microvascular network. Anatomy of neovessels is abnormal and characterized by large size, varying diameter, convolution and blood extravasation. Neovessels have a defective ultrastructure: formation of large "mother vessels" requires degradation of venular and capillary basement membranes. Mother vessels give birth to numerous "daughter vessels". Diffuse neoangiogenesis can be observed before appearance of macroscopic peritoneal metastasis. Multiplication of the peritoneal capillary surface by neoangiogenesis surface increases the part of cardiac outflow directed to the peritoneum.

Intraoperative Incident Dark Field Imaging of the Human Peritoneal Microcirculation

“…When peritoneal structure and function are compromised in response to pathological processes, this is expected to result in changes to the vasculature [1, 6, 10]. Generally, the peritoneum is expected to have a relatively low blood vessel density; this can however be altered in response to disease [1, 11, 12].…”

Recommendations for pathological diagnosis on biopsy samples from peritoneal dialysis patients

“…Another systematic review of peritoneal vascular anatomy and function also highlights that the peritoneal vascular plexus and vascularization is under the influence of neurological factors as well as other physical, chemical, and hormonal factors [103]. Furthermore, recent image analysis tools and methodologies enable us to overcome semiquantitative evaluation, i. e. vascular network analysis, collagen tissue quantification, computer-assisted quantification of immuno-stains [104][105][106]. These studies suggest important areas for future study in order to better understand the pathophysiological impact of biocompatible PD solutions.…”

Changes in the coelomic microclimate during carbon dioxide laparoscopy: morphological and functional implications

“…The total peritoneal surface area in an adult human (1.5-2 m 2 ) is similar to the skin surface area. The visceral component comprises approximately 70 % and parietal 30 % of the total peritoneal surface area [4]. The mesothelial surface of the peritoneum normally acts as a semipermeable membrane for solute and nutrient transfer and a barrier to larger molecules or foreign objects such as cancer cells.…”

“…The ECM is made up of the BM and submesothelial layer with a reservoir of signalling molecules. These respond to ECM exposure or secreted growth factors such as fibroblast growth factor (FGF) [4,5,18]. The peritoneal integrins are comprised of an α (α 2 , α 3 , α 5 , α 6 , or α v ) and β (β 1 or β 3 ) subunit combination.…”

“…This is equivalent to 60-100 mL blood/ minute [4,46]. The decrease in cardiac output related to pneumoperitoneum is not sufficient to explain the decrease in splanchnic blood flow [11].…”