DEVELOPMENT OF THE ALIMENTARY SYSTEM- I

MOHD ASIM KHAN

moaskhan@kku.edu.sa

▪ At the end of this lecture the student should be able to:

1. Describe the development of the primitive gut tube
2. Describe the divisions and derivatives of the primitive gut tube
3. Describe the development of the lower anal canal
4. Describe the embryological basis of the congenital anomalies related to the primitive gut tube and lower anal canal

ADDITIONAL RESOURCE
https://www.youtube.com/watch?v=cBSyOgjTGVU
The development of the gastrointestinal tract
 ALIMENTARY SYSTEM
▪ Digestive tract from the mouth to the anus with all its associative glands and organs
▪ The primordial gut at the beginning of the 4th week is closed by:
- Oropharyngeal membrane at its cranial end
- Cloacal membrane at its caudal end
STRUCTURE GERM LAYER
1. Most of the epithelium and glands of the alimentary system 1. Endoderm of the primordial gut
2. Epithelium at the cranial end of the alimentary tract 2. Ectoderm of the stomatodeum
3. Epithelium at the caudal end of the alimentary tract 3. Ectoderm of the proctodeum (anal pit)
4. Muscular and connective tissue and other layers of the wall 4. Splanchnic mesenchyme surrounding the
of the alimentary tract primordial gut
▪ The gut is divided into three parts
1. Foregut 2. Midgut 3. Hindgut
▪ The arterial supply of the gut is by:
1. Celiac trunk (Foregut) 2. Superior mesenteric artery (Midgut) 3. Inferior mesenteric artery (Hindgut)
 DERIVATIVES OF THE FOREGUT
▪ The primordial pharynx and its derivatives
▪ The lower respiratory system
▪ The esophagus and stomach
▪ The duodenum, just proximal to the
opening of the bile duct
▪ The liver, biliary apparatus (hepatic ducts,
gallbladders, and bile duct), and pancreas
All of the foregut derivatives except the
pharynx, the respiratory tract and thoracic
part of the esophagus are supplied by Derivatives of the foregut at 5th week of the human development
Reference: Netter’s Atlas of Human Embryology, By Cochard, 1st edition
CELIAC TRUNK
(Artery of the foregut)
 DEVELOPMENT OF THE ESOPHAGUS
▪ Epithelium and Glands:
- Endoderm
▪ Striated muscle:
- Mesenchyme in the 4th and 6th pharyngeal arches
▪ Smooth muscle:
- Splanchnic mesenchyme

Stages in the histogenesis of the esophagus

A: At 7 weeks; B: At 8 weeks; C: At 12 weeks; D: At 34 weeks
Reference: Human Embryology and Developmental Biology, By Carlson, 3rd Edition
 DEVELOPMENT OF THE STOMACH FOOD= 4 ALPHABETS= 4 WEEK

- A slight dilation forms in the foregut in week 4 that gives rise to the primordial stomach
- First appears as a fusiform enlargement that is oriented in the median plane
- The primordial stomach enlarges and broadens ventrodorsally
- The dorsal border grows more quickly than its ventral border, resulting in the greater
curvature and lesser curvature, respectively

The development of the stomach External features of the stomach

Reference: Color Atlas of Clinical Embryology, By Moore, 2nd Edition Reference: Lippincott Illustrated Reviews – Anatomy, By Harrell and Dudek, 1st Edition
 ROTATION OF THE STOMACH
- The primordial stomach undergoes a 90° clockwise rotation around its longitudinal axis
- The effects of rotation on the stomach are as follows:
1. The ventral border (lesser curvature) moves to the right
▪ The ventral mesentery is carried to the right side and eventually forms the lesser omentum
2. The dorsal border (greater curvature) moves to the left
▪ The dorsal mesentery is carried to the left side and eventually forms the greater omentum
R=Right
L=Left

R L
R L
 ROTATION OF THE STOMACH
2. BEFORE ROTATION OF THE STOMACH
* The cranial and caudal ends of the stomach are in the median plane
DURING ROTATION AND GROWTH OF THE STOMACH
* The cranial region of the stomach moves to the left and slightly inferiorly
* The caudal region of the stomach moves to the right and superiorly

R=Right
L=Left
R L
Arrows indicate direction of movement

Rotation of the stomach

Reference: Human Embryology, By Larsen, 5th edition
 ROTATION OF THE STOMACH
3. AFTER ROTATION OF THE STOMACH
* The stomach assumes its final position with its long axis almost transverse to the long
axis of the body
▪ The right vagus nerve (CN X) becomes positioned on the dorsal surface of the stomach
(as the posterior vagal trunk and supplies the dorsal surface)
▪ The left vagus nerve (CN X) becomes positioned on the ventral surface of the stomach
(as the anterior vagal trunk and supplies the ventral surface)
A B C D

Rotation of the stomach

Reference: Lippincott Illustrated Reviews – Anatomy, By Harrell and Dudek, 1st Edition
 DUODENUM
▪ Develops from:
1. Caudal part of the foregut (Supplied by branches of celiac artery)
2. Cranial part of the midgut (Supplied by branches of superior mesenteric artery)

Development of the duodenum- 4 weeks

Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 DERIVATIVES OF THE MIDGUT RIGHT LEFT

▪ Duodenum distal to the opening of the bile duct

▪ Jejunum
▪ Ileum
▪ Cecum
▪ Appendix
▪ Ascending colon
▪ Proximal 2/3 of the transverse colon
All of the midgut derivatives are supplied by the
SUPERIOR MESENTERIC ARTERY (Artery of the midgut)

Derivatives of the midgut

Reference: Essential Clinical Anatomy, By Moore, 5th Edition
 MIDGUT LOOP
▪ Suspended from the dorsal abdominal wall by an elongated mesentery
▪ Elongates and forms a ventral, U-shaped loop that projects into the proximal part of the
umbilical cord at the beginning of the 6th week and is called a physiological umbilical herniation
▪ Umbilical herniation occurs because there is not enough room in the abdomen for the rapidly
growing midgut
▪ The midgut loop communicates with the yolk sac through the narrow omphaloenteric duct
until the 10th week

Rotation of the midgut, as seen from the left

A: During the 6th week, the midgut is situated in the proximal part of the umbilical cord
A1: Transverse section through the midgut loop, showing the initial relationship of the
limbs of the midgut loop to the superior mesenteric artery

Omphalo-: Greek, Navel (Umbilicus)

Enteric: Of or relating to the small intestine
MNEMONIC DEVICE
MIDGUT= 6 ALPHABETS =6th WEEK
MIDGUT LOOP = 10 ALPHABETS = 10th WEEK
Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 SUPERIOR MESENTERIC ARTERY
▪ SUPERIOR MESENTERIC ARTERY
* Supplies the midgut loop
* Forms the axis of the rotation
* Divides the midgut loop into
- Cranial limb (cranial to artery) or preaxial segment
- Caudal limb (caudal to artery) or postaxial segment

Rotation of the midgut, as seen from the left

A: During the 6th week, the midgut is situated in the
proximal part of the umbilical cord
A1: Transverse section through the midgut loop,
showing the initial relationship of the limbs of the
midgut loop to the superior mesenteric artery

Midgut loop
Reference: Human Embryology, By Larsen, 5th edition Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 MIDGUT LOOP
▪ MIDGUT LOOP:
* Consists of: Cranial and Caudal limb
- Cranial limb forms:
1. Jejunum
2. Upper part of the ileum
- Caudal limb forms:
1. Cecal diverticulum – Develops cecum & appendix
2. Lower part of the ileum
3. Ascending colon
4. Proximal 2/3 of the transverse colon
Right Left Rotation of the midgut, as seen from the left
A: During the 6th week, the midgut is situated in the
proximal part of the umbilical cord
A1: Transverse section through the midgut loop,
showing the initial relationship of the limbs of the
midgut loop to the superior mesenteric artery
90 + 180= 270
Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 ROTATION OF MIDGUT LOOP
- The midgut loop rotates 90 degrees counterclockwise around the axis of the superior
mesenteric artery while in the umbilical cord and brings the cranial limb (small intestine) of
the midgut loop to the RIGHT and the caudal limb (large intestine) to the LEFT

Rotation of the midgut, as seen from the left

A: During the 6th week, the midgut is situated in the proximal part of the umbilical cord
A1: Transverse section through the midgut loop, showing the initial relationship of the limbs of the midgut loop to the superior mesenteric artery
B: A later stage, showing the beginning of midgut rotation
B1: Illustration of the 90- degree counterclockwise rotation that carries the cranial limb of the midgut to the right

Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition Counterclockwise= Anticlockwise
 ROTATION OF MIDGUT LOOP – RETURN OF MIDGUT TO ABDOMEN
- During the 10th week, with enlargement of the abdominal cavity, the intestines return to the abdomen
(reduction of the physiologic midgut hernia)
- The small intestines return first, passing posterior to the superior mesenteric artery, and occupies the central
part of the abdomen
- The large intestine undergoes a further 180-degree counterclockwise rotation as it returns to the abdomen and
comes to occupy the right side of the abdomen
- Thus, the midgut loop rotates a total of 270° counterclockwise around the superior mesenteric artery

Rotation of the midgut, as seen from the left

C: At approximately 10 weeks, the intestines return to the abdomen C1: Illustration of a further rotation of 90 degrees
D: By approximately 11 weeks, all of the intestines return to the abdomen D1: A further 90-degree rotation of the gut, for a total of 270 degrees
E: The late fetal period Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 ABNORMAL ROTATION
ABNORMAL ROTATION EMBRYOLOGICAL BASIS
Non-rotation of the midgut - Results in the caudal limb of the midgut loop returning to the abdomen first
(=Left-sided colon) - Small intestine lies on the right side of the abdomen & the entire large intestine lies on the left

Non-rotation of the gut

Right Left

Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 BODY WALL DEFECT
BODY WALL DEFECT EMBRYOLOGICAL BASIS
Congenital omphalocele - Results in persistence of the herniation of the abdominal contents into the
Omphalo: Greek, Navel (Umbilicus) proximal part of the umbilical cord due to failure of the bowel to return to the
-cele: Hernia
body cavity from its physiological herniation during the 10th week
- The viscera, which may include liver, small and large intestines, stomach, spleen,
or gallbladder are covered by amnion
- Caused by failure of the body walls to fuse at the umbilical ring because of
defective growth of mesenchyme

A: Omphalocele showing failure of the intestinal loops to return to the body cavity after physiological herniation
Omphalocele in a still born
B: Omphalocele in a newborn
Reference: Medical Embryology by Langman, 9th Edition Reference: Human Embryology and Developmental Biology, By Carlson, 3rd Edition
 VITELLINE DUCT ABNORMALITY
VITELLINE DUCT ABNORMALITY EMBRYOLOGICAL BASIS
Meckel’s diverticulum - Blind pouch
(= Ileal diverticulum) - 5 cm long located on the antimesenteric border of the ileum about 40 to 60 cm
from the ileocecal junction
- Contain patches of gastric and pancreatic tissues
- Represents the persistence proximal portion of the yolk sac
- Great clinical significance because it sometimes become inflamed and causes
symptoms that mimic appendicitis

Antimesenteric border
Anti: Opposite

Reference: Clinical Anatomy by Snell, 7th edition

MEMORY DEVICE FOR RULE OF 2s

2% (of the population)
2 feet (proximal to the ileocecal valve)
2 inches (in length)
2 types of common ectopic tissue (gastric and pancreatic)
2 years is the most common age at clinical presentation
Reference: Human Embryology and Developmental Biology, By Carlson, 3rd Edition 2:1 Male:Female ratio
 CECUM AND APPENDIX
▪ The primordium of the cecum and the
appendix appears in the sixth week as a
swelling on the antimesenteric border of
the caudal limb of the midgut loop
MNEMONIC DEVICE
CAECUM= 6 ALPHABETS= 6th WEEK

Successive stages in the development of the cecum and appendix

A: At 6 weeks B: At 8 weeks C: At 12 weeks D: At birth E: Adult
Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 DERIVATIVES OF THE HINDGUT
▪ Distal one-third of the transverse colon
▪ Descending colon
▪ Sigmoid colon
▪ Rectum
▪ Superior (Upper) part of the anal canal
▪ The epithelium of the urinary bladder
▪ Most of the urethra
All of the hindgut derivatives are supplied by
the INFERIOR MESENTERIC ARTERY
(Artery of the hindgut)
Development of gastrointestinal tract
E: Esophagus; ST: Stomach; HD: Hepatic diverticulum
GB: Gall bladder; VP: Ventral pancreatic bud
DP: Dorsal pancreatic bud; YS: Yolk sac
VD: Vitelline duct; AL: Allantois; CL: Cloaca
Reference: Lippincott Illustrated Reviews – Anatomy, By Harrell and Dudek, 1st Edition
 HINDGUT
▪ TERMINAL END OF THE HINDGUT
* CLOACA
- Endoderm-lined chamber (pouch) that is
in contact with the surface ectoderm of
proctodeum to form the cloacal
membrane
- Receives the allantois ventrally
* CLOACAL MEMBRANE
- Composed of Cloacal region in embryos at successive stages of development
1. Endoderm of the cloaca Reference: Medical Embryology by Langman, 9th Edition
2. Ectoderm of the proctodeum
 CLOACA
Partitioned by the urorectal septum into the rectum and upper anal canal and the urogenital sinus

A B C

A: Partitioning of the cloaca into the rectum and urogenital sinus by the urorectal septum at 4 week
B: Partitioning of the cloaca into the rectum and urogenital sinus by the urorectal septum at 6 week
C: Enlargement of the cloacal region

Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 CLOACAL MEMBRANE
▪ The cloacal membrane is partitioned by the urorectal septum (7th week) into the:
1. Anal membrane (dorsally) MNEMONIC DEVICE
2. Urogenital membrane (ventrally) CLOACAL=7 ALPHABETS= 7th WEEK
▪ The urorectal septum fuses with the cloacal membrane at the future site of the gross anatomical perineal body
MNEMONIC DEVICE
- The anal membrane usually ruptures at the end of the 8th week of development MEMBRANE = 8 ALPHABETS= 8th WEEK

Perineal body
Cloacal region in embryos at successive stages of development

Reference: Medical Embryology by Langman, 9th Edition Reference: Essential Clinical Anatomy, By Moore, 5th Edition
 ANAL CANAL
- The upper anal canal develops from the hindgut
- The lower anal canal develops from the proctodeum
Proctodeum is the invagination of surface ectoderm caused by a proliferation of mesoderm surrounding the anal membrane
-The junction between the upper and lower anal canals is indicated by the pectinate line, which also marks the site
of the former anal membrane
- In the adult, the pectinate line is located at the lower border of the anal columns

A
A: Partitioning of the cloaca into the rectum and urogenital sinus by the urorectal septum at 7 week
B: The rectum and anal canal showing their developmental origin
Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
 ANORECTAL ANOMALIES
▪ Most anorectal anomalies result from abnormal development of the urorectal septum,
resulting in incomplete separation of the cloaca into urogenital and anorectal parts
▪ Lesions are classified as high or low, depending on whether the rectum ends superior or
inferior to the puborectalis muscle respectively

Stages in the subdivision of the cloaca by the urorectal septum Puborectalis

A: In the fifth week; B: In the sixth week; C: In the eighth week
Reference: Human Embryology and Developmental Biology, By Carlson, 3rd Edition Reference: Essential Clinical Anatomy, By Moore, 5th Edition

HIGH ANORECTAL ANOMALIES
ANORECTAL AGENESIS, WITH
OR WITHOUT A FISTULA
Rectovaginal fistula
Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition
HIGH ANORECTAL ANOMALIES
EMBRYOLOGICAL BASIS
- In anorectal agenesis, the rectum ends superior to the puborectalis muscle
- Most common type of anorectal anomaly Agenesis: Refers to the failure of an organ to develop
- Rectum ends blindly but there is a: Genesis: Origin or mode of formation of something
1. Fistula to the bladder (RECTOVESICAL FISTULA)
2. Fistula to the urethra (RECTOURETHRAL FISTULA)
3. Fistula to the vagina (RECTOVAGINAL FISTULA)
4. Fistula to the vestibule of the vagina (RECTOVESTIBULAR FISTULA)
- Anorectal agenesis with a fistula is the result of incomplete separation of the
cloaca by the urorectal septum
Rectourethral fistula Rectovesical fistula
Reference: Human Embryology and Developmental Biology, By Carlson, 3rd Edition
 LOW ANORECTAL ANOMALY
LOW ANORECTAL ANOMALY EMBRYOLOGICAL BASIS
MEMBRANOUS ATRESIA OF ANUS - Anus is in the normal position but a thin layer of tissue separates the anal canal from
(IMPERFORATE ANUS) the exterior
- Anal membrane is thin enough to bulge on straining
- Results from failure of the anal membrane to perforate at the end of the 8th week
Atresia: Absence of an opening or passage in the body Imperforate: Having no opening

Membranous anal atresia Imperforate anus

Reference: Before we are Born- Essentials of Embryology and Birth Defects, By Moore, 8th Edition Reference: Medical Embryology by Langman, 9th Edition