Histology of the parietal peritoneum: a scoping review of microanatomy and potential relevance to preperitoneal analgesia
In brief
Peritoneum contains pain-sensing nerves, supporting study of a new block target
A scoping review found that the abdominal parietal peritoneum has a connective tissue layer containing blood vessels and sensory nerve fibers, including fibers linked to pain and mechanical sensation. These findings suggest the tissue may be more than a passive membrane, but evidence that it can guide effective regional analgesia remains limited and needs human studies.
- Journal
- Minerva anestesiologica (Q2)
- Published
- 6 November 2026
- Study design
- Narrative review / expert opinion
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Francesco Marrone, Sandeep Diwan, Carla Stecco, Gian Marco Petroni, Tommaso Sorrentino, Pierfrancesco Fusco
- PMID
- 42992819
- DOI
- 10.23736/S0375-9393.26.20167-0
Why clinicians should know about it
- Picked for Histology (top studies of the week, 8 November 2026): Scoping review maps peritoneal microanatomy, innervation, and vascularization
Abstract
BACKGROUND: The abdominal preperitoneal plane beneath the posterior rectus sheath has been recently described as a potential target for regional analgesia. Techniques such as ultrasound-guided preperitoneal or deep rectus sheath blocks aim to deposit local anesthetic adjacent to the abdominal parietal peritoneum, a structure traditionally regarded as a serosal membrane. Some anatomical and clinical evidence suggests that the parietal peritoneum may represent a more complex neurovascular interface relevant to pain transmission. METHODS: A systematic scoping review of the literature was conducted to synthesize available histological evidence on the abdominal parietal peritoneum. Studies investigating its microanatomy, vascularization, and innervation were included. Given the heterogeneity of study designs and outcomes, a descriptive mapping approach was adopted without quantitative synthesis. RESULTS: The included studies show that the parietal peritoneum is composed of a mesothelial layer supported by a submesothelial connective tissue matrix. The matrix contains collagen fibers, microvasculature, immune cells, and both myelinated and unmyelinated nerve fibers. Neuroanatomical findings indicate sensory afferents originating from the thoracolumbar nerves, as well as mechanoreceptive and nociceptive fibers within the submesothelial layer. CONCLUSIONS: While conclusive evidence of visceral afferent innervation is still scarce, these experimental observations imply a more complex sensory organization. Overall, these results may support the notion of the parietal peritoneum as a biologically active fascial interface. This perspective may provide a conceptual framework for considering the preperitoneal plane as a potential target in abdominal pain. Further translational and human-based studies are needed to clarify its role in regional analgesia.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.