DEVELOPMENT OF THE

GASTROINTESTINAL SYSTEM- PART 2

Dr. Mallika Indran BDS, PhD, FICCDE
Saba University School of Medicine

Office Hours: 12-2.00 pm, Monday – Friday

and
by Appointment
Email: m.indran@saba.edu
Greater Sac and Lesser Sac Formation
http://www.indiana.edu/~anat550/gianim/sdo/sdo.html

 Rotation of the stomach in the antero-

posterior axis pulls the duodenum into
a C shaped position
 Pyloric part of stomach moves to the
right and upward, and the cardia of
the stomach moves to the left and
slightly downward
 The development of the omenta and
rotations of the foregut structures
produce distinct spaces of the
peritoneal cavity
 The space
posterior to
the stomach
is called the
lesser sac

The space
anterior to and
inferior to the
stomach is
called the
greater sac
Leaves of the greater omentum fuse with each other and with the
transverse mesocolon. The transverse mesocolon covers the duodenum
Regional Organogenesis: Liver and Pancreas cont…
Pancreas cont..
 Rotation of the duodenum and stomach causes ventral pancreatic bud to swing
around dorsally so it lies BELOW and BEHIND the dorsal pancreatic bud
 Then the parenchyma and duct systems of the two buds fuse
CONTRIBUTIONS FROM THE DORSAL AND VENTRAL PANCREATIC BUDS:
TO FORM THE PANCREAS TO FORM THE PANCREATIC DUCT

Distal part of dorsal Main pancreatic duct (of

Dorsal pancreatic Upper part of head, pancreatic duct + entire Wirsung)
bud neck, body, tail ventral pancreatic duct

Ventral pancreatic Uncinate process, Proximal part of Accessory

bud lower part of head dorsal pancreatic pancreatic duct (of
duct Santorini)
Regional Organogenesis: Liver and Pancreas cont…
Liver

Liver bud appears as an

outgrowth of endodermal
epithelium at distal end of
foregut

Then it grows towards septum

transversum and penetrates it

While hepatic cells continue to

penetrate the septum
transversum, the connection
between liver bud and foregut
narrows and forms the bile duct
Regional Organogenesis: Liver and Pancreas cont…
Liver cont…..
As the liver bud enlarges,
vitelline veins present in the
septum transversum are broken up
and form hepatic sinusoids

Endoderm cells of the liver bud

form the liver parenchyma and
the bile capillaries

 Hematopoiesis begins during 6th

Splanchnic mesoderm of septum
transversum forms the capsule, week
connective tissue, hematopoietic  Bile formation begins when the
cells and kupffer cells fetus is about three months old
Regional Organogenesis: Gall Bladder and Cystic Duct

Bile duct gives rise to a

small ventral outgrowth
called cystic
diverticulum

Distal part of cystic

diverticulum forms the
gall bladder (GB), and
the proximal part
forms the cystic duct
Anomalies associated with the development of the
liver, gall bladder and cystic duct
 Congenital malformations of
the liver: Rare
Anomalies of the gall bladder:
 Intrahepatic gallbladder:
 Occurs when the cystic diverticulum
grows inside the hepatic bud
 Floating gallbladder:
 Occurs when cystic bud lags behind the
hepatic bud and becomes suspended
from the liver by a mesentery
Anomalies of the duct system
 Biliary atresia
 Obliteration of extrahepatic and/or
intrahepatic ducts and replacement
with fibrous tissue
Regional Organogenesis:
Spleen

 During the 5th week, mesenchymal cells between

the two layers of the dorsal mesogastrium condense
and form the spleen
Regional Organogenesis:
Duodenum
 Caudal foregut gives rise to the part of duodenum above
Duodenum is derived the opening of the hepatopancreatic duct
from:
 Cranial part of midgut gives rise to the rest of the
 Caudal most part duodenum
of foregut and
 Cranial part of
 As the stomach rotates the duodenum forms a C shaped loop
the midgut and rotates to the right
 Growth of the pancreas swings the duodenum to the right
side of the abdominal cavity. The
duodenum and pancreas are now
retroperitoneal

 The dorsal mesoduodenum

disappears entirely except in the
region of the duodenal cap
 The duodenal cap is
intraperitoneal
Regional Organogenesis:
Duodenum cont…

 During the 2nd month the

lumen of duodenum is
obliterated by proliferation
of cells in its walls
 Shortly thereafter, the lumen
gets recanalized
Defects associated with duodenum development

 Duodenal atresia
 due to failure to
recanalize the lumen
 associated with trisomy
21
 "double bubble" sign

Double Bubble Sign. Supine radiograph of the abdomen

demonstrates a dilated stomach (S) and an accompanying
dilated proximal duodenum (D). There is no gas in the
bowel distal to the dilated duodenum. This is called the
"double bubble" sign and usually indicates the presence of
duodenal atresia
Development of the Midgut

Lower
duodenum

Jejunum,
Ileum

Cecum
Midgut
Vermiform
appendix

Ascending colon

Proximal 2/3
of transverse
colon
Midgut development starts with the formation of the
primary intestinal loop

 Midgut and its

mesentery elongates
rapidly resulting in the
formation of the primary
intestinal loop
 At its apex, the loop
remains in open
connection with the yolk
sac through the vitelline
duct
Superior mesenteric artery divides the primary
intestinal loop into a cranial and caudal part

Cephalic limb develops into:

 Distal part of duodenum

 Jejunum

 Most of ileum

Caudal limb develops into:

 Lower part of ileum

 Cecum

 Appendix

 Ascending colon

 Proximal two-thirds of
transverse colon
Rapid growth of the liver exceeds volume of abdominal cavity, so the
growing primary intestinal loop herniates through the umbilical cord

 Herniation of the growing primary

intestinal loop into the extraembryonic
cavity in the umbilical cord is known as
physiolgical umbilical herniation
 Then, the herniated loop rotates around
an axis formed by superior mesenteric
artery
Herniated intestinal loop rotates
90˚ anticlockwise around the
superior mesenteric artery
 Cranial limb swings down and to the right
 Caudal limb swings up and to the left
Cranial limb:
 Cranial limb elongates rapidly, coils as it elongates
and forms jejunal-ileal loops
 Most proximal part of the cranial limb forms the
duodenum
Caudal limb:
 Lengthens but does not coil
 Slow lengthening controlled by cecal diverticulum
 Forms the large intestine
Herniated intestinal loop returns into the abdominal cavity
during the 10th week

Proximal portion of jejunum, the first

part to reenter the abdominal cavity,
comes to lie on left side

Later returning loops gradually settle

more and more to the right

During this process, the intestinal loop

undergoes a further 180˚ anticlockwise
rotation
When viewed from the front, the intestinal rotation is 270
counterclockwise in total, when it is complete
Cecal bud in the caudal limb of the intestinal loop
is the last part to reenter the abdominal cavity
 After entering the abdominal cavity,
it temporarily lies in the right upper
quadrant directly below the right
lobe of the liver
 From here it descends into the right
iliac fossa, placing the ascending
colon and hepatic flexure on the
right side of the abdominal cavity
 During this process, the distal end of
the cecal bud forms a narrow
diverticulum:
 Appendix (retrocecal/retrocolic
position)

Note the attachment of the vitelline duct to the gut at

the region of the ileum. The duct normally regresses
during development, but not always
With rotation and coiling of the intestinal loop, some parts
lose their mesentery and become secondarily retroperitoneal
Ascending and descending portions of
colon, duodenum and pancreas are
pressed against peritoneum of the
posterior abdominal wall and lose
their mesenteries

Appendix and sigmoid colon retain

their free mesenteries

Transverse mesocolon fuses with

posterior wall of greater omentum but
maintains its mobility
Defects associated with gut herniation and
rotation: vitelline duct abnormalities
Vitelline duct abnormalities of some sort occur in ~2% of all live births. Note that
these aberrant structures are almost always found along the ileal portion of the GI
tract

Both ends of the Vitelline duct

vitelline duct
Persistence of a
transform into
small portion of the
fibrous cords, and
vitelline duct
the middle portion
forms a large cyst
remains patent over
its entire length,
forming a direct
communication with
the umbilicus
Meckel Diverticulum

 In 2-3% of people, a small portion of

vitelline duct persists as ileal
diverticulum (of Meckel)
 In adults, ileal diverticulum is about 2 feet
(60cm) from ileo-cecal valve
 2-3 inches long
 May contain two types of heterotopic
tissue
 Gastric or pancreatic tissue
 If present, may cause ulceration, bleeding or
perforation

 Inflammation of Meckel diverticulum may mimic

appendicitis. Therefore during appendectomy,
ileum should be checked for the presence of
Meckel diverticulum, if it is found to be present
it should be removed along with appendix
Defects associated with gut herniation and rotation:
omphalocele
Defects associated with gut herniation and rotation:
omphalocele

 Persistence of
physiological hernia :
viscera fail to return
 Herniated viscera are
covered by a sac
formed by peritoneum
 Usually associated with
other congenital
anomalies like trisomy
13, 18
Comparison of Omphalocele and Gastroschisis
Omphalocele Gastroschisis

 Non return of physiological herniation
 Bowel loops are covered with amnion
 Amniotic covering holds the bowel loops
together
 Therefore spherical
 Closure defect in the ventral body wall
 Bowel loops are not covered by amnion
 Bowel loops are not held together
 O

Omphalocele (O) protruding from Gastroschisis (red arrows)

the abdominal wall spherical Bowel loops protruding through
nature is due to the fact that there the abdominal wall are not
is a covering of amnion that covered by amnion and so have a
holds the bowel loops in place ragged appearance
Defects associated with gut herniation and
rotation: abnormal rotation
Absent or incomplete secondary rotation
Roatation is only 90˚.
Colon and cecum return first
and settle on the left side of abdominal cavity.
Later returning loops then move more and
more to right, resulting in a left-sided colon
Reversed rotation
Primary loop rotates 90˚ clockwise .
Transverse colon passes behind the
duodenum and lies behind the superior
mesenteric artery
Defects associated with gut herniation and
rotation: volvulus, ischemia and atresia

Volvulus (left figure) : Twisting of the gut tube. A portion of the gut tube is fixed to the body
wall; subsequent rotation twists the gut tube leading to obstruction and compromised blood
supply
Ischemia/atresia (right figure): blood supply to a portion of the mid- or hindgut may become
compromised during rotation or herniation leading to ischemia and loss (A), fibrosis (B),
septation (C), or narrowing (D) of that portion
Commonly Occurring Gut Atresias and Stenoses

 May occur anywhere along

the intestine
 Most common in duodenum
 Upper duodenum atresias:
lack of recanalization
 From distal duodenum
caudally: vascular accidents
 Cause of accidents:
malrotation, volvulus,
gastroschisis, omphalocele
and other factors
(misexpression of HOX genes)
Apple Peel Atresias

 10% of atresias
 Proximal Jejunum is a
common site
 Intestine is short
 The portion distal to the
lesion coiled around a
mesenteric remnant

"Corkscrew" duodenum in
malrotation with a midgut
volvulus
Gross specimen demonstrates apple peel small bowel. Note the
distention of the proximal small intestine (white arrowheads), the
shortening of the dorsal mesentery (arrow), and the distal
spiraled segment of the small intestine (black arrowheads)
Malrotation. The intestine occupies an
intermediate position between that of
nonrotation and the normal postnatal
position. The cecum and the terminal ileum
are displaced upward and medially
Midgut volvulus. Image demonstrates the
“corkscrew” appearance of the proximal small
bowel (arrows) as it twists around the superior
mesenteric artery
Hindgut Development
Hindgut: Part of the gut tube extending from the distal one-third of the transverse
colon to the upper portion of the anal canal

Distal 1/3 of
transverse colon

Descending colon

Sigmoid colon
Hind-gut
Rectum

Upper part of anal

canal
Internal lining of
urinary bladder
and urethra
What is cloaca?
Cloaca (sewer) is the common chamber for the hindgut and urinary systems

Formation of Cloaca:
 Incorporation of allantois into the hindgut during the 4th week of
gestation due to folding of the embryo. Endodermal
 Cloacal membrane (plate): Membrane formed during 3rd week
at the caudal end of the embryo from adhesion between epiblast
and hypoblast cells. Later, it covers the cloaca
What is cloaca?
Cloaca (sewer) is the common chamber for the hindgut and urinary systems

Division of Cloaca:
 Mesodermal urorectal septum starts to divide cloaca from 4th week and
reaches cloacal membrane to completely divide cloaca by 7 weeks
 Anteriorly (connected to allantois): Urogenital sinus
 Posteriorly (connected to hindgut): Anorectal canal
 Apex of urorectal septum (in contact with cloacal membrane): Primitive
perineum or perineal body
 Cloacal membrane breaks down to form the anal opening: During 7th week
Cloacal Division
The urorectal septum divides the cloaca into
urogenital sinus and anorectal canal

2 potential problems can arise:

•“TOO MUCH” mesoderm:
imperforate anus (D)
•“NOT ENOUGH” mesoderm: atresia
and/or fistulas (A,B,C)

C
Development of the Anal canal
Proctodeum: Ectodermally lined pit that invaginates to form the lower third of the anal canal

 Ectoderm in the region of the

proctodeum proliferates and
Superior 2/3 Endodermal invaginates:
cloaca  Anal pit
 Anal membrane
Anal degenerates and establishes
canal Ectoderm lined continuity between upper
Inferior 1/3 anal pit or and lower parts
proctodeum
 The junction between the
ectodemal and endodermal
regions of the anal canal:
 Pectinate line (just below
the anal columns):
 Epithelium changes from
columnar to stratified
squamous
Hirschprung Disease (congenital megacolon)

 Occurs in ~1:5000 births

 Caused by failure of neural crest cells
to migrate into a portion of the colon
 Leads to dilatation of colon proximal to
absent ganglia
 Signs and symptoms include:
 constipation or small, infrequent
bowel movements
 bilious vomiting 3-4 hours after
feeding (if totally obstructed)
Barium enema: The contrast material
 Abdominal distension
outlines a bowel segment without
 Surgically repaired by removing ganglions (arrows), above which
affected region dilatation is visible
 References
42

 Sadler, T.W., Langman’s Medical Embryology. 13th ed.

2015
 Dudek, R.W. BRS Embryology. 5th ed. 2011
 Gary Schoenwolf, Larsen’s Human Embryology, 5th ed.
2015