Dr.

Eftekhar Shamkhee Abbood

Senior lecturer obstetrician and
gynecologist
M.B.CH.B/CABOG
Ibn-Sina University of Medical
and Pharmaceutical Sciences
Development of
the digestive
system
Development of the digestive system
The development of the digestive system begins
as a simple blind-ended gut tube. The accessory
digestive organs form as out pouchings from the
primitive gut tube, whereas formation of
the intestines require them to first protrude out
into the umbilical cord (physiological
herniation) before retracting back into the
abdominal cavity..
First, the proximal foregut consists of
the pharyngeal gut (pharynx), which extends from the
oropharyngeal membrane to the respiratory
diverticulum. This region is crucial to the development
of the pharyngeal apparatus and ultimately the head
and neck.
Second, the distal foregut extends from the
pharyngeal tube to the liver bud.
Third, the midgut extends from the liver bud to the
junction between the right two-thirds and the left third
of the transverse colon.
Fourth, the hindgut extends from the left third of the
transverse colon to the cloacal membrane
Foregut
The foregut gives rise to the:
•pharynx
•the lower respiratory system
•the esophagus
•the stomach
•the proximal half of the duodenum
•the liver
•the biliary apparatus
• the pancreas
The derivatives of the foregut, except for the pharynx and the
lower respiratory system, are mostly supplied by the celiac
artery (trunk).
Esophagus
During the third week of gestation, a respiratory
diverticulum (lung bud) forms as an outgrowth
from the ventral wall of the proximal foregut.
While the lung bud continues to expand, it
becomes separated from the foregut, which
forms the esophagus. Initially, the esophagus is
short, but becomes rapidly elongated as a result
of the growth and relocation of
the heart and lungs.
Stomach
During the fourth week of gestation, the
rudimentary stomach appears as a
fusiform-shaped dilation of the distal foregut.
Subsequently, its appearance and position
drastically changes; the latter can be better
understood by visualizing a longitudinal axis
and an antero-posterior axis around which the
stomach rotates.
The stomach rotates 90 degrees clockwise around its
longitudinal axis, resulting in its left side facing
anteriorly and its right side posteriorly. This explains
why the left vagus nerve innervates the anterior wall,
as it once innervated the left side of the stomach,
whereas the right vagus nerve innervates the posterior
wall, as it once innervated the right side. Concurrent
with this rotation, cellular proliferation occurs much
faster in the posterior wall of the stomach than in the
anterior wall, resulting in the formation of
the greater and lesser curvatures, respectively
The stomach also rotates around its
antero-posterior axis, resulting in the caudal end
(pyloric part) to move upward and to the right
and the cranial end (cardiac part) slightly
downward and to the left. Thus, the stomach
assumes its final position, with its pylorus
located superiorly to the left and its cardia
inferiorly to the right.
Duodenum
During the fourth week of gestation, the duodenum
begins to develop from two sources: the caudal part of
the foregut and the cranial part of the midgut, where
the junction lies just distal to the origin of the bile
duct. The developing duodenum forms a C-shaped
loop that initially projects ventrally. However, once
the stomach rotates, the duodenum rotates to the right
and becomes pressed against the posterior abdominal
wall, thus becoming retroperitoneal. Due to its dual
origin, the duodenum is supplied by branches of the
celiac trunk and the superior mesenteric artery.
Liver and biliary apparatus
The development of the liver begins during the fourth
week of gestation, with the appearance of the hepatic
diverticulum (liver bud) as an outgrowth from the
ventral wall of distal foregut. The stalk connecting the
diverticulum and the foregut narrows and forms the
bile duct, whereas the gallbladder and the cystic duct
form as a ventral outgrowth from the bile duct.
Initially, the bile duct opens anteriorly into the
duodenum, but ends up posteriorly due to the
rotational changes of the duodenum
Pancreas
The pancreas is formed by two separate pancreatic
buds that later join. Specifically, the dorsal pancreatic
bud forms as an outgrowth from the dorsal wall of the
duodenum, whereas the ventral pancreatic bud forms
as an outgrowth from the ventral wall of the duodenum
along with the bile duct. When the duodenum rotates
and takes its C-shape form, it pulls the ventral
pancreatic bud dorsally and inferior to the ventral
pancreatic bud. Subsequently, the pancreatic buds
along with their rudimentary duct systems fuse to give
rise to the pancreas.
The ventral pancreatic bud forms the uncinate
process and the inferior part of the head of the
pancreas. The dorsal pancreatic bud forms the
superior part of the head, the neck, and the body
of the pancreas. The distal part of the dorsal
pancreatic duct and the entire ventral pancreatic
duct form the main pancreatic duct (of
.(Wirsung
Midgut
The midgut gives rise to the:
•distal half of the duodenum
•the jejunum
•the ileum
•the cecum
•the appendix
•the ascending colon
•the proximal two-thirds of the transverse colon
The derivatives of the midgut are supplied by
the superior mesenteric artery.
During the fifth week of gestation, the midgut
undergoes a rapid elongation that occurs much faster
than that of the abdominal cavity, resulting in the
formation of the primary intestinal loop. At its apex,
the loop remains in open communication with the yolk
sac via the vitelline duct, while the superior mesenteric
artery runs along the axis of the loop. The cranial
limb of the loop will develop into the inferior half of
the duodenum, the jejunum, and proximal half of the
ileum. The caudal limb of the loop will develop into
the distal half of the ileum, the cecum, the ascending
colon, and the proximal two-thirds of the transverse
colon.
By the sixth week, the continuing elongation of the midgut,
combined with the pressure exerted by the dramatic growth of
the abdominal organs, force the primary intestinal loop to
protrude into the umbilicus (physiological herniation).
Concurrently, the loop rotates 90 degrees counterclockwise
around the axis of the superior mesenteric artery, resulting in
the cranial limb to move caudally and to the embryo’s right,
and the caudal limb to move cranially and to the embryo’s left.
While this rotation takes place until the eighth week of
gestation, the lengthening jejunum and ileum develop into a
series of folds known as the jejunal-ileal loops, whereas the
expanding cecum gives rise to a wormlike diverticulum,
.the vermiform appendix
During the tenth week, the herniated midgut retracts
into the abdomen. The mechanism responsible for this
retraction is not fully understood, but may involve the
increase in size of the abdominal cavity. As the
intestinal loops reenter the abdomen, it rotates an
additional 180 degrees counterclockwise around the
axis of the superior mesenteric artery, thus having
travelled for a total of 270 degrees. As a result,
the cecum, being initially positioned under the liver,
becomes displaced inferior, pulling down the proximal
hindgut to form the ascending colon.
becoming intraperitoneal.
 Hindgut
The hindgut gives rise to the distal third of the:
❑transverse colon
❑descending colon
❑sigmoid colon
❑rectum
❑upper two-thirds of the anal canal
The derivatives of the hindgut are supplied by
the inferior mesenteric artery.
During the early weeks of development, the terminal
portion of the hindgut enters the posterior portion of
the cloaca, whereas the allantois enters the anterior
portion; the cloaca and the allantois form the future
anorectal canal and the urogenital sinus, respectively.
The cavity of the cloaca is lined by endoderm, whereas
its ventral boundary is lined by surface ectoderm; the
latter is known as the cloacal membrane
By the seventh week of gestation, the urorectal
septum (a layer of mesoderm) grows between the
allantois and the hindgut. It divides the cloaca into
the urogenital sinus and the anorectal canal, while its
tip forms the future perineal body. The urogenital
sinus forms the future bladder, parts of the urethra,
and the phallus, whereas the anorectal canal develops
into the rectum and most of the anal canal.
Specifically, while the upper two-thirds of the
anorectal canal is derived from the endoderm of the
hindgut, the lower one-third is derived from the
surface ectoderm of the cloaca.
Omphalocele
As previously mentioned, the midgut undergoes
a physiological herniation into the umbilicus
before retracting back to the abdominal cavity. If
a retraction does not occur, the infant may be
born with an umbilical hernia or an
omphalocele. In contrast to the former, an
omphalocele involves a larger herniation that
can consist of an entire bowel or a liver.
Gastroschisis
Gastrochisis involves the protrusion of
abdominal viscera through the anterior body
wall, lateral to the umbilicus (usually on the
right). Unlike an omphalocele, in gastroschisis
the umbilical ring closes, therefore the
herniation occurs lateral to the umbilicus rather
than through it.
Omphalocele
Gastrochisis
Thank you