This paper reviews the structure, function, and clinical significance of peritoneal mesothelium, once thought to be a passive membrane, but now known to play an active role in exchanges between the peritoneal cavity and the blood. The advent of continuous ambulatory peritoneal analysis (CAPD) has revived interest in the peritoneum, whose ultrastructure is much changed by CAPD.
Studies of the healing of mesothelium have shown that the new mesothelium develops from subperitoneal perivascular connective tissue cells, and not by a process of centripetal growth from the wound margins as in the healing of other epithelial surfaces.
Peritoneal mesothelial cells possess fibrinolytic properties, which may be important in preventing fibrinous adhesions from being converted to permanent fibrous adhesions, which may cause intestinal obstruction. Mesothelium also produces prostacyclin. These properties have led to the use of mesothelium as a substitute for endothelium, both for coating prosthetic vascular grafts, and also in peritoneal tube grafts for replacing segments of vein. The resurgence of interest in the peritoneal mesothelium provides a stimulus for clinician and anatomist to cooperate in further exploration of its clinical potential.