Peritoneal innervation: embryology and functional anatomy

Abstract

The parietal peritoneum (PP) is innervated by somatic and visceral afferent nerves. PP receives sensitive branches from the lower intercostal nerves and from the upper lumbar nerves. Microscopically, a dense network of unmyelinated and myelinated nerve fibers can be found all over the PP. The unmyelinated fibers are thin and are ending just underneath the PP. The myelinated fibers can penetrate the PP to reach the peritoneal cavity, where they lose their myelin sheath and are exposed to somatic and nociceptive stimuli. PP is sensitive to pain, pressure, touch, friction, cutting and temperature. Noxious stimuli are perceived as a localized, sharp pain. The visceral peritoneum (VP) itself is not innervated, but the sub-mesothelial tissue is innervated by the autonomous nerve system. In contrast to the PP, the visceral submesothelium also receives fibers from the vagal nerve, in addition to the spinal nerves. VP responds primarily to traction and pressure; not to cutting, burning or electrostimulation. Painful stimuli of the VP are poorly localized and dull. Pain in a foregut structure (stomach, duodenum or biliary tract) is referred to the epigastric region, pain in a midgut structure (appendix, jejunum, or ileum) to the periumbilical area and pain from a hindgut source (distal colon or rectum) is referred to the lower abdomen or suprapubic region. Peritoneal adhesions can contain nerve endings. Neurotransmitters are acetylcholine, VIP, serotonin, NO, encephalins, CGRP and substance P. Chronic peritoneal pain can be exacerbated by neurogenic inflammation, e.g. by endometriosis.

The Contribution of the Left Phrenic Nerve to Innervation of the Esophagogastric Junction

“…Areas of nonmyelinated and small‐diameter myelinated fibers suggest the presence of autonomic and sensory nerves (Kandel et al, ). Sensory nerve endings in the phrenicoabdominal branches participate in innervation of the parietal peritoneum, in particular in the central region of the diaphragm (Struller et al, ). Afferent recordings from the right phrenic nerve in dogs have been associated with mechanosensitive areas in the hepatic veins, the liver, and the inferior vena cava (Kostreva and Pontus, ).…”

Akutes Abdomen: Diagnostik

“…Neben dem abdominellen Schmerz können weitere klinische Begleitphänomene und anamnestische Faktoren bei der Diagnosefindung helfen, jedoch ist eine sichere Diagnose auf dem alleinigen Boden der Anamnese und des klinischen Untersuchungsbefundes nicht immer sicher möglich [5]. Abdominelle Schmerzen sind nicht immer spezifisch [6], was auch an der nervalen Innervation des abdominellen Peritoneums liegt [7]. Das viszerale Peritoneum ist primär nicht selbst innerviert, sondern nur das mesotheliale Gewebe [7].…”

“…Abdominelle Schmerzen sind nicht immer spezifisch [6], was auch an der nervalen Innervation des abdominellen Peritoneums liegt [7]. Das viszerale Peritoneum ist primär nicht selbst innerviert, sondern nur das mesotheliale Gewebe [7]. Im Gegensatz zum parietalen Peritoneum, das auf Basis von Nozizeptoren Schmerzen genau lokalisieren und charakterisieren kann, reagiert das viszerale Peritoneum nur auf Dehnungs-und Druckstimuli und kann Schmerz nur ungenau und wenig charakteristisch wiedergeben [7].…”

Features of the Intercostal Nerves Topography in the Anterior Abdominal Wall Depending on the Body Type

“…Особое распространение в лечении больных со срединными послеоперационными грыжами получила протезирующая герниопластика «sublay preperitoneal» [3,6]. Но, до настоящего времени проблема лечения пациентов с данной патологией окончательно не решена, поскольку все еще высок риск возникновения осложнений из-за повреждения межреберных нервов при применении сетчатых протезов [5,10,11,19,20]. Для предотвращения развития синдрома хронической боли после герниопластики важно знать особенности иннервации передней брюшной стенки у пациентов с различными типами телосложения [2].…”