THE GREATER OMENTUM AS A PERIPHERAL ORGAN OF THE IMMUNE SYSTEM: MORPHOLOGICAL AND FUNCTIONAL ASPECTS

Authors

DOI:

https://doi.org/10.21272/eumj.2025;13(4);899-909

Keywords:

greater omentum, peritoneum, milky spots, mesothelium, lymphoid tissue, adipose tissue

Abstract

Introduction. The greater omentum, despite its apparent simplicity at first glance, is a complex anatomical structure with multiple functions. Active involvement of the greater omentum in the protection of the abdominal cavity, along with its unique plastic properties, makes it an important subject of study for surgeons and researchers. Moreover, the presence of specialized lymphoid structures in the greater omentum highlights its significant role in the body’s immune system.

Methods. The analytical review was conducted based on published articles, books, educational manuals and monographs. The literature search was performed on the global Internet using scientific databases such as Google Scholar, Web of Science and PubMed, as well as the electronic library of Poltava State Medical University.

Results and Discussion. The greater omentum is not merely a fatty fold in the abdominal cavity but a complex organ with numerous functions. Although it has been known to humanity since the ancient times, its detailed study has begun recently. This organ consists of several layers of peritoneum and contains a significant amount of adipose tissue, blood vessels, nerves and lymphoid structures known as “milky spots.” It is the milky spots that endow the greater omentum with immune properties, helping the body combat infections. In addition to its immune function, the greater omentum performs several other critical roles: it protects internal organs from damage, participates in metabolic processes and can even be used in surgery for tissue reconstruction. The shape and size of the greater omentum can vary among individuals, depending on the unique characteristics of their bodies. With age, the structure and functions of this organ also undergo changes. Despite numerous studies, the greater omentum still holds many mysteries. Further research into this organ will allow for a deeper understanding of the processes occurring in the human body and the development of new methods for treating various diseases.

Conclusions. The analysis of the presented data provides a detailed understanding of the greater omentum as a dynamic organ that plays a key role in the functioning of the abdominal cavity. Derived from the peritoneum, it is not merely a passive element but an active participant in numerous physiological processes. The mobility of the greater omentum, facilitated by its structure, allows it to function as a protective “apron,” shielding internal organs from damage and infection. Additionally, its proximity to many organs of the digestive system contributes to maintaining homeostasis within the abdominal cavity. The presence of milky spots gives the greater omentum immunological properties. These structures act as specialized “outposts” of the immune system, continuously monitoring the antigenic composition of the abdominal cavity. Their location within the greater omentum underscores the importance of this organ in providing local immunity.

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References

Wang AW, Prieto JM, Cauvi DM, Bickler SW, De Maio A. The Greater Omentum-A Vibrant and Enigmatic Immunologic Organ Involved in Injury and Infection Resolution. Shock. 2020;53(4):384-390. https://doi.org/10.1097/SHK.0000000000001428.

Li X, Ding Y, Haddad YW, Geng X. Greater Omentum: Multifaceted Interactions in Neurological Recovery and Disease Progression. Aging Dis. 2024;15(6):2381-2394. Published 2024 Feb 19. https://doi.org/10.14336/AD.2024.0213.

Di Nicola V. Omentum a powerful biological source in regenerative surgery. Regen Ther. 2019;11:182-191. Published 2019 Aug 8. https://doi.org/10.1016/j.reth.2019.07.008.

Konovalenko S, Filenko B, Royko N, Kosharyi V. Morfofunktsionalni osoblyvosti velikogo cheptsya, yak organu imunogenezu ta regeneratsii. Perspektyvy ta innovatsii nauky. 2023;12(30):949-59. https://doi.org/10.52058/2786-4952-2023-12(30)-949-959.

Pellicciaro M, Vella I, Lanzoni G, Tisone G, Ricordi C. The greater omentum as a site for pancreatic islet transplantation. CellR4 Repair Replace Regen Reprogram. 2017;5(3):e2410.

Hryn V, Kostylenko Y, Maksymenko O. General Morphological Characteristics of the Results of Experimental Modeling of Aseptic Peritonitis. Ann Anat. 2023;250:152160. https://doi.org/10.1016/j.aanat.2023.152160. Epub 2023 Sep 21. PMID: 37739240.

Liebermann-Meffert D. The greater omentum. Anatomy, embryology, and surgical applications. Surg Clin North Am. 2000;80(1):275-xii. https://doi.org/10.1016/s0039-6109(05)70406-0

Akimov OY, Kostenko VO. Functioning of nitric oxide cycle in gastric mucosa of rats under excessive combined intake of sodium nitrate and fluoride. Ukr Biochem J. 2016 Nov-Dec;88(6):70-5. https://doi.org/10.15407/ubj88.06.070.

Pryshlyak A, Konovalenko S, Kosharnyi V. Anatomical and physiological features of the large cap as a target for metastasis. Prospects and innovations of science. 2023;13(31):791-800 https://doi.org/10.52058/2786-4952-2023-13(31)-791-800.

Suzuki D, Kim JH, Shibata S, Murakami G, Rodríguez-Vázquez JF. Topographical anatomy of the greater omentum and transverse mesocolon: a study using human fetuses. Anat Cell Biol. 2019;52(4):443-454. https://doi.org/10.5115/acb.19.112

Cherkasov V.G., Bobryk I.I., Guminsky Y.Y., Kovalchuk O.I. (eds.). International anatomical terminology (Latin, Ukrainian, Russian and English equivalents): a textbook. Vinnytsia: Nova Knia, 2010. 392 с.

Raxmatovich NJ, qizi AMA. Features of Anatomy of the Greater Omentum. IJOT [Internet]. 2021Sep.29 [cited 2025Jan.19];3(9):66-8. Available from: https://journals.researchparks.org/index.php/IJOT/article/view/2198

Arner P, Andersson DP, Thörne A, Wirén M, Hoffstedt J, Näslund E, Thorell A, Rydén M. Variations in the size of the major omentum are primarily determined by fat cell number. J Clin Endocrinol Metab. 2013 May;98(5):E897-901. https://doi.org/10.1210/jc.2012-4106. Epub 2013 Mar 29. PMID: 23543656.

Gelberg HB. Alimentary System and the Peritoneum, Omentum, Mesentery, and Peritoneal Cavity. Pathologic Basis of Veterinary Disease. 2017:324–411.e1. https://doi.org/10.1016/B978-0-323-35775-3.00007-2. Epub 2017 Feb 17. PMCID: PMC7895291.

Ahmed S, Barakat S, Ashraf MS, Saeed F, et al. Omentum: An underappreciated organ with pleiotropic functions. World J Gastroenterol. 2021 Dec 15;27(46):7889-7910. https://doi.org/10.3748/wjg.v27.i46.7889.

Stepanchuk AP, Fedorchenko IL, Pryshliak AM, Piliuhin AV, Shepitko K. The normal architectonics of the greater omentum vasculature in elderly people of both gender. World of Medicine and Biology 2022; 2(80): 232-7. https://doi.org/10.26724/2079-8334-2022-2-80-232-237

Kataoka, J., Nitta, T., Ota, M. et al. Variations in the size of the major omentum are primarily determined by fat cell number.: report of a case. surg case rep. 2019;.5:76 https://doi.org/10.1186/s40792-019-0618-5.

Wilkosz, Sylwia & Ireland, Grenham & Khwaja, Nadeem & Walker, Michael & Butt, Richard & Giorgio-Miller, Alexander & Herrick, Sarah. A comparative study of the structure of human and murine greater omentum. Anatomy and embryology.2005; 209: 251-61. https://doi.org/10.1007/s00429-004-0446-6.

Hryn V, Maksymenko O, Stupak D. Morphological differences between the lesser and the greater omenta in albino rats. Ann Anat. 2024 Oct;256:152299. https://doi.org/10.1016/j.aanat.2024.152299. Epub 2024 Jul 4. PMID: 38971449.

Fedorchenko I. General characterization of the main morphometric parameters of the shape and angioarchitectonics of the human greater omentum. Act. Probl. of the Modern Med. [Internet]. 13, November 2019 [cited January 16, 2025;19(4):148-53. available from: https://visnyk-umsa.com.ua/index.php/journal/article/view/174

Hryn V, Kostylenko Y, Maksymenko O. The greater omentum and similar serous formations of testis in male white rats. Folia Morphol (Warsz). 2023;82(4):854-861. https://doi.org/10.5603/FM.a2022.0095. Epub 2022 Dec 6. PMID: 36472401.

Loureiro C, Gomes D, Ferreira V, Pereira JA, Castro-Sousa F. The Omentum: An Overview of Its Functions and Clinical Significance. J Clin Med. 2023 Nov 21;12(22):7127. https://doi.org/10.3390/jcm12227127.

Michaud A, Drolet R, Noël S, Paris G, Tchernof A. Visceral fat accumulation is an indicator of adipose tissue macrophage infiltration in women. Metabolism. 2012;61(5):689-698. https://doi.org/10.1016/j.metabol.2011.10.004

Nauli AM, Matin S. Why Do Men Accumulate Abdominal Visceral Fat? Front Physiol. 2019;10:1486. Published 2019 Dec 5. https://doi.org/10.3389/fphys.2019.01486

Khan T, Muise ES. The physiological role of omental adipose tissue: A review. Adipocyte. 2020 Dec;9(1):242-275. https://doi.org/10.1080/21626351.2020.1775087.

Mutsaers SE. Mesothelial cells: their structure, function and role in serosal repair. Respir Res. 2004;5(1):10. https://doi.org/10.1186/1465-9921-5-10.

Li J, Guo T. Role of Peritoneal Mesothelial Cells in the Progression of Peritoneal Metastases. Cancers (Basel). 2022;14(12):2856. Published 2022 Jun 9. https://doi.org/10.3390/cancers14122856

Iizuka T, Ono M, Yamazaki R, Kagami K, Mitani Y, Sakai S, et al. Wavy floating greater omentum findings are useful for differentiating the etiology of fetal ascites. Diagnostics (Basel, Switzerland). 2021;11(2) https://doi.org/10.3390/diagnostics11020326.

Schurink B, Cleypool CGJ, Bleys RLAW. A rapid and simple method for visualizing milky spots in large fixed tissue samples of the human greater omentum. Biotechnic & Histochemistry. 2019;94(6):429-34 https://doi.org/10.1080/10520295.2019.1583375 .

Kosharnyi, V, Lysachenko, O, Fylenko, B, Roiko, N. Аdipose tissue of the greater omentum: morphology and function. Bulletin of Problems Biology and Medicine 2023 Issue 3, 170, 52-56. 1. 52. https://doi.org/10.29254/2077-4214-2023-3-170-52-56.

Luo L, Liu M. Adipose tissue in control of metabolism. J Endocrinol. 2016 Dec;231(3):R77-R99. https://doi.org/10.1530/JOE-16-0211. PMID: 27935822; PMCID: PMC7928204.

Choe SS, Huh JY, Hwang IJ, Kim JI, Kim JB. Adipose Tissue Remodeling: Its Role in Energy Metabolism and Metabolic Disorders. Front Endocrinol (Lausanne). 2016 Apr 13;7:30. https://doi.org/10.3389/fendo.2016.00030. PMID: 27148161; PMCID: PMC4829583.

Richard AJ, White U, Elks CM, et al. Adipose Tissue: Physiology to Metabolic Dysfunction. [Updated 2020 Apr 4]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555602/.

Lachaud CC, Rodriguez-Campins B, Hmadcha A and Soria B (2015) Use of mesothelial cells and biological matrices for tissue engineering of simple epithelium surrogates. Front. Bioeng. Biotechnol. 3:117. https://doi.org/10.3389/fbioe.2015.00117

Vittal R, Mickelsen D, Hood JD. Mesothelial Cell Biology and Function in the Peritoneum and Beyond. Semin Cell Dev Biol. 2020 Jan;97:149-157. https://doi.org/10.1016/j.semcdb.2019.05.020.

Trionfetti F, Montaldo C, Caiello I, Bontempi G, Terri M, Tiberi M, Marchant V, Domenici A, Menè P, Cordani M, Zwergel C, Prencipe G, Ruiz-Ortega M, Valente S, Mai A, Tripodi M, Strippoli R. Mechanisms of mesothelial cell response to viral infections: HDAC1-3 inhibition blocks poly(I:C)-induced type I interferon response and modulates the mesenchymal/inflammatory phenotype. Front Cell Infect Microbiol. 2024 Feb 27;14:1308362. https://doi.org/10.3389/fcimb.2024.1308362. PMID: 38476167; PMCID: PMC10927979. ].

Sousa-Pinto B, Sá-Sousa A, Vieira RJ, Amaral R, Klimek L, Czarlewski W, … Kaidashev I, et al. Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK-air® real-world data. Allergy. 2022 Sep;77(9):2699-2711. https://doi.org/10.1111/all.15275.

Ibukuro K, Ishii R, Fukuda H, Abe S, Tsukiyama T. Collateral venous pathways in the transverse mesocolon and greater omentum in patients with pancreatic disease. AJR Am J Roentgenol. 2004 May;182(5):1187-93. https://doi.org/10.2214/ajr.182.5.1821187. PMID: 15100116.

Dayan JH, Voineskos S, Verma R, Mehrara BJ. Managing Venous Hypertension in Vascularized Omentum Lymphatic Transplant: Restoring Bidirectional Venous Drainage. Plast Reconstr Surg. 2018 Feb;141(2):326e-327e. https://doi.org/10.1097/PRS.0000000000004092. PMID: 29068884; PMCID: PMC5796759.

Janardhan HP, Jung R, Trivedi CM. Lymphatic System in Organ Development, Function, and Regeneration. Circ Res. 2023 Apr 28;132(9):1181-1184. https://doi.org/10.1161/CIRCRESAHA.123.322867. Epub 2023 Apr 27. PMID: 37104565; PMCID: PMC10155258.

Kataru RP, Mehrara BJ. Lymphatic Vessels in Obesity and Diabetes. Microcirculation. 2020 May;27(4):e12607. https://doi.org/10.1111/micc.12607.

Escobedo N, Oliver G. The Lymphatic Vasculature: Its Role in Adipose Metabolism and Obesity. Cell Metab. 2017;26(4):598-609. https://doi.org/10.1016/j.cmet.2017.07.020

Den Brok MH, Holz LE, Kuijpers ME, et al. The peritoneal cavity as an immunological niche. Immunol Rev. 2024 May;321(1):149-163. https://doi.org/10.1111/imr.13339.

Cleypool CGJ, Mackaaij C, Schurink B, Bleys RLAW. Morphological hallmarks facilitating distinction of omental milky spots and lymph nodes: an exploratory study on their discriminative capacity. Histol Histopathol. 2020 Nov;35(11):1275-1284. https://doi.org/10.14670/HH-18-254. Epub 2020 Sep 14. PMID: 32926399.

Aspelund F, Alitalo K. The lymphatic vasculature: from development to disease. Physiol Rev. 2023 Oct 1;103(4):2115-2164. https://doi.org/10.1152/physrev.00042.2022.

Okonogi N, Kuwahara R, Nishimura S, et al. Milky spots as immune niches and their functional diversity. Immunol Rev. 2024 May;321(1):164-178. https://doi.org/10.1111/imr.13340.

Turley SJ, Lee JW, Resser JR, et al. Omental milky spots and lymphatics in immunity to cancer and infection. Nat Rev Immunol. 2022 Mar;22(3):163-177. https://doi.org/10.1038/s41577-021-00631-4.

Okabe Y. Development and organization of omental milky spots. Immunol Rev. 2024;324(1):68-77. https://doi.org/10.1111/imr.13337

Akasaka H, Lee W, Ko SY, Lengyel E, Naora H. Normal saline remodels the omentum and stimulates its receptivity for transcoelomic metastasis. JCI insight. 2023;8(12) https://doi.org/10.1172/jci.insight.167336.

Cleypool CGJ, Schurink B, van der Horst DEM, Bleys R. Sympathetic nerve tissue in milky spots of the human greater omentum. Journal of anatomy. 2020;236(1):156-64 https://doi.org/10.1111/joa.13077.

Ksyonz IV, Kostylenko YP, Liakhovskyi VI, Konoplitskyi VS, Maksymovskyi VY. Milky spots of the greater omentum / Act. Probl. of the Modern Med. [Internet]. 24, May 2023 [cited in 16, January 2025];23(2.2):135-40. available from: https://visnyk-umsa.com.ua/index.php/journal/article/view/807

Liu J, Geng X, Li Y. Milky spots: omental functional units and hotbeds for peritoneal cancer metastasis. Tumour Biol. 2016 May;37(5):5715-26. https://doi.org/10.1007/s13277-016-4887-3. Epub 2016 Jan 29. PMID: 26831659; PMCID: PMC4875158.

Doron O, Chen T, Wong T, Tucker A, Costantino P, Andrews R, et al. Cranial transposition and revascularization of autologous omentum: a novel surgical technique for resection of recurrent glioblastoma multiforme. Neurosurgical Review. 2022;45(3):2481-7 https://doi.org/10.1007/s10143-022-01767-7.

Meza-Perez S, Randall TD. Immunological Functions of the Omentum. Trends Immunol. 2017 Jul;38(7):526-536. https://doi.org/10.1016/j.it.2017.03.002. Epub 2017 Jun 1. PMID: 28579319; PMCID: PMC5812451.

Menendez M, Drozd A, Borawska K, et al. IL-1β Impacts Vascular Integrity and Lymphatic Function in the Embryonic Omentum. Circulation Research. 2022 Feb;130(3):366-383. https://doi.org/10.1161/circresaha.121.319032. PMID: 34986653; PMCID: PMC8813910.

Van den Bossche J, Baardman J, de Winther MPJ, et al. Metabolic and Immunological Functions of the Omentum. Physiol Rev. 2023 Oct 1;103(4):2281-2346. https://doi.org/10.1152/physrev.00037.2022.

Srivastava M, Chandra A, R R, Nigam J, Rajan P, Parmar D, et al. Expression of Antimicrobial Peptides and Cytokines in Human Omentum Following Abdominal Surgery. Cureus. 2021;13(8):e17477 https://doi.org/10.7759/cureus.17477.

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2025-12-31

How to Cite

Fedorchenko, I. ., Maksymenko, O. ., Hryn, V. ., Bilash, V. ., Tykhonova, O. ., & Tarasenko, Y. . (2025). THE GREATER OMENTUM AS A PERIPHERAL ORGAN OF THE IMMUNE SYSTEM: MORPHOLOGICAL AND FUNCTIONAL ASPECTS. Eastern Ukrainian Medical Journal, 13(4), 899–909. https://doi.org/10.21272/eumj.2025;13(4);899-909

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LITERATURE REVIEW. GENERAL AND INTERNAL MEDICINE