The relation between chronic irritation of peritoneal mesothelium and the formation of adhesions

Abstract

During a systematic investigation of the normal and pathological reactions of the peritoneal mesothelium, certain rather surprising facts have been revealed which are interesting because of their bearing on the question of adhesions. Elsewhere experiments have been reported in which rats received repeated injections of solutions of glucose, the mesothelium undergoing certain changes of a morphological character which were not followed by adhesions. It seemed important to determine to what extent such changes could be produced without sufficient injury occuring to cause the development of adhesions. Such experiments have been carried out by the repeated introduction into the peritoneal cavity of various types of mild irritants, the best results having been obtained with laked heterogenous blood. Cats were given injections of 10 to 20 c.c. of laked rabbit's blood made isotonic with NaC1, the dose being repeated twice weekly over a period of 3 to 6 months. In such animals when the procedures were carefully guarded to prevent undue injury on puncture of the abdominal wall, and precautions taken to avoid any septic involvement, there resulted very remarkable changes in the entire mesothelial membrane without the formation of a single adhesion. The peritoneum on section was often made up of two or three layers of cuboidal or columnar cells, attaining at times a thickness of 20 micra, and yet such a peritoneal lining seemed entirely adequate to prevent the formation of adhesions. From such observations the conclusion seems wholly justified that the presence of a complete layer of peritoneal lining cells, no matter how much their morphological appearance may be altered by such irritations as those used, is entirely sufficient to prevent the adherance of the two layers of peritoneum and thus prevent adhesions.