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Peritoneal innervation: embryology and functional anatomy.

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Pleura and Peritoneum
|March 27, 2019
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Summary

The parietal peritoneum (PP) is sensitive to various stimuli, while the visceral peritoneum (VP) responds mainly to traction and pressure. Understanding their distinct nerve pathways is crucial for diagnosing peritoneal pain.

Keywords:
enteric nervous systeminnervationmyelinated fibersperitoneumunmyelinated fibersvisceral pain

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Area of Science:

  • Neuroscience
  • Anatomy
  • Pain Medicine

Background:

  • The parietal peritoneum (PP) and visceral peritoneum (VP) have distinct sensory innervations.
  • PP receives somatic and visceral afferent nerves from intercostal and lumbar nerves.
  • VP's sub-mesothelial tissue is innervated by the autonomic nervous system, including vagal nerve fibers.

Purpose of the Study:

  • To elucidate the differential innervation of the parietal and visceral peritoneum.
  • To describe the sensory modalities and pain referral patterns associated with each peritoneal layer.
  • To highlight the role of neurotransmitters and neurogenic inflammation in chronic peritoneal pain.

Main Methods:

  • Microscopic examination of nerve fiber networks in the parietal peritoneum.
  • Analysis of afferent nerve pathways supplying both peritoneal layers.
  • Review of known responses to various stimuli and pain referral patterns.

Main Results:

  • Parietal peritoneum (PP) is densely innervated by myelinated and unmyelinated fibers, sensitive to pain, pressure, touch, temperature, and cutting.
  • Visceral peritoneum (VP) is primarily innervated by the autonomic system, responding to traction and pressure, with poorly localized pain.
  • Specific pain referral patterns are observed for foregut, midgut, and hindgut structures.

Conclusions:

  • The distinct innervation of PP and VP explains their differential sensory responses and pain characteristics.
  • Nerve endings in peritoneal adhesions and the role of neurotransmitters contribute to chronic peritoneal pain.
  • Neurogenic inflammation, as seen in endometriosis, can exacerbate chronic peritoneal pain.