EMBRYOLOGY OF THE DIGESTIVE

SYSTEM
 The Digestive System
•The primitive gut forms during the 4th week as a
result of head, tail and lateral folding of the embryo.
•The endoderm lined cavity is incorporated into
the embryo, while the yolk sac and the allantois
remain temporarily outside the embryo.
• During folding, somatic mesoderm is attached to
the body wall to give rise to the parietal
peritoneum. 
• The mesoderm immediately associated with the
endodermal tube also contributes to most of the
wall of the gut tube. 
 The Digestive System
• Germ layer contributions:
– endoderm:  gives rise to the epithelium and glands of
the digestive tract; mucosal epithelium, mucosal
glands, and submucosal glands. 
– mesoderm:  gives rise to muscular and fibrous
elements; lamina propria, muscularis mucosae,
submucosa and blood vessels, muscularis externa, and
adventitia/serosa
– neural crest: gives rise to neurons and nerves of the
submucosal plexus and myenteric plexus
• The epithelium at the cranial and caudal ends of the
digestive tract is derived from the ectoderm of the
stomodeum and the proctodeum (anal pit).
 The Digestive System
Primitive gut divisions
• Foregut- from oropharyngeal membrane to anterior
intestinal portal
• Midgut – anterior intestinal portal to the posterior
intestinal portal.
• Hindgut: extends from the posterior intestinal
portal to cloacal membrane
• Further folding and growth of the embryo
causes the communication of the gut with the
yolk sac to continue to get smaller and the
foregut, midgut, and hindgut to become
further defined
• Splanchnic mesoderm envelopes
the endodermal lined gut tube and
forms a dorsal mesentery.
• Foregut, midgut and the hind gut
are suspended from the abdominal
wall by the dorsal mesentery.
• The septum transversum forms a
ventral mesentery in the midline
from the diaphragm and anterior
abdominal wall to the umbilicus.
• The ventral mesentry- exists only in
the region of the terminal part of
the esophagus, the stomach, and
upper duodenum.
 4th week 5th week

Langman’s fig 14-14 Langman’s fig 14-4

the liver and stomach have dorsal and ventral

mesenteries whereas the rest of the gut has only a
dorsal mesentery.
 mesentery
• Peritoneum fold enveloping a segment of the gut tube
• Suspends the organ from the body wall
• Carries vessels, nerves & lymphatics for the organ
• Mesenteries include:
• mesentery proper: suspends the jejunum and the ileum
• mesoappendix: suspends the vermiform appendix
• transverse mesocolon: suspends the transverse colon
• sigmoid mesocolon: suspends the sigmoid colon
• The gut is divided into foregut, midgut, and
hindgut based on the arterial supply:
– Foregut derivatives in the abdomen are supplied
by branches of the coeliac artery
– Midgut derivatives are supplied by branches of
the superior mesenteric artery
– Hindgut derivatives are supplied by branches of
the inferior mesenteric artery
 General Outline of GI organ
development
Foregut Midgut Hindgut

·      Duodenum: distal to bile ·     Last 1/3 of transverse

Distal end of Oesophagus
duct colon (variable)
·         Stomach ·         Jejunum ·         Descending colon

 duodenum: proximal to ·         Ileum ·       sigmoid colon

bile duct

Gall bladder
·         Ascending Colon  
rectum
·         Liver ·    2/3 of transverse  
colon (variable)
·         Pancreas    
 The Digestive System

• As the gut tube tube develops, the endoderm

proliferates rapidly and actually temporarily
occludes the lumen of the tube around the 5th
week. 
• Growth and expansion of mesoderm components
in the wall coupled with apoptosis of some of the
endoderm at around the 7th week causes re-
canalization of the tube such that by the 9th week,
the lumen is open again.
 Development of stomach
• Initially a tubular structure
• By the 4th week, it appears as a fusiform dilation
of the foregut oriented in the median plane
• Originally flattened with
dorsal and ventral borders
 Development of stomach
---by the 5th week, the posterior part of the stomach grows
faster than the anterior portion forming a posterior greater
and anterior lesser curvature
---by 7-8th week, the stomach enlarges and carries out a 90
degrees clockwise rotation around the longitudinal axis, so
its ventral border (lesser curvature) moves to the right and
its dorsal border (greater curvature) moves to the left
 Development of stomach
rotation along the anteroposterior axis:
the caudal(pyloric) end of the stomach moves upward and to
the right; the cephalic( cardiac) end moves downward and to
the left
The fundus develops as an outward bulge in the cephalic region.
• The ventral mesentery
degenerates in the
region of the future
peritoneal cavity.
• It exists only in the
region of the terminal
part of the esophagus,
the stomach, liver and
upper duodenum
• The mesentery of the stomach is called the mesogastrium.
Because there is no ventral mesentery below the foregut,
the ventral mesentery is the ventral mesogastrium
• Dorsal and ventral mesogastrium of the stomach become
the greater and lesser omenta, respectively.
 •During formation of the ventral mesentery, the liver
grows so rapidly that the septum transversum can no
longer accommodate it, so it protrudes between the
2 leaves of the mesentery, dividing it into an anterior
part, the falciform ligament (from liver to anterior
abdominal wall) and a posterior part, the lesser
omentum (between the liver and ventral borders of
the stomach and duodenum)
– The free edge of the falciform ligament contains the
umbilical vein which is obliterated after birth to form
the ligamentum teres hepatis
– The free edge of the lesser omentum contains the
common bile duct, the portal vein, and the hepatic
artery
• Initially, the lesser omentum is oriented in a
sagittal plane, but with rotation of the
stomach and growth of the liver, it acquires a
frontal position so that its lower edge forms
the upper margin of the epiploic foramen of
Winslow - the entrance into the lesser
peritoneal sac behind the stomach
 Lesser Sac
• Begins as small isolated clefts
in the dorsal mesogastrium,
that soon join to form a single
cavity
• Rotation of stomach pulls the
dorsal mesogastrium to the
left enlarging the cavity
• The lesser sac expands
transversely and cranially and
lies between the stomach and
the posterior abdominal wall
• The superior part of the
omental bursa is cut off as the
diaphragm develops. Inferiorly Inferior recess

it persists as the superior

recess of the lesser sac
• The inferior part grows within
the 4-layered greater
omentum forming the inferior
recess of the omental bursa
• The inferior recess later on
closes down because of fusion
of the layers of the greater
omentum
• The dorsal mesogastrium expands, extending from the
greater curvature of the stomach and reflecting on itself
forming a sac consisting of four layers of peritoneum –the
greater omentum
• Later the middle two layers of peritoneum fuse to form a
single sheet but initially the space inside forms the inferior
recess of the lesser sac.
• The greater omentum ascend to the transverse colon fusing
with it and the transverse mesocolon.
• Eventually, the development of the spleen divides the dorsal
mesogastrium into lienorenal and glastrosplenic ligaments.
• Superiorly (above the spleen), they merge to form the
gastrophrenic ligament , which passes from the back of the
fundus of the stomach to the diaphragm.
 Mesentery
• Ventral mesogastrium- derivatives
Lesser omentum
Falciform ligament

• Dorsal mesogastrium- derivatives

Greater omentum
Gastrosplenic ligament
Lienorenal ligament
Phrenicosplenic ligament
Gastrophrenic ligament
 Development of the Duodenum
• Development begins early in 4th week, from the caudal part of
the foregut, cranial part of the midgut and sorrounding
splanchnic mesoderm
• Grows rapidly, forms a C-shaped loop that projects ventrally
• Rotation of stomach pulls it to the right and dorsally, bringing
it in a retro-peritoneal position
• During 5-6th weeks, its lumen obliterates due to proliferation
of epithelial cells
• Recanalization is complete by the end of embryonic period
• Most of the ventral mesentery disappears by this time. The
free border which does remain lies between the duodenum
and the liver and forms the anterior border of the epiploic
foramen and the duodenohepatic ligament. This mesentery is
also a portion of the lesser omentum.
 Fixation of the Duodenum
• Posterior surface of the rotated duodenum comes
in contact with parietal peritoneum
• Mesoduodenum blends with the parietal
peritoneum covering the posterior abdominal wall
• Most of the posterior surface of the duodenum
becomes retroperitoneal except the first 2.5 cm
and the duodeno-jejunal flexure.
• Because of its derivation from foregut and midgut,
the duodenum is supplied by branches of the
coeliac and superior mesenteric artery
Stomach rotation moves the duodenum to the right
and cranially
 Development of the Liver
• Liver appears in 4th week, as
a ventral bud from the
caudal part of the foregut
called hepatic diverticulum,
• The bud grows into the
septum transversum (which
is forming the ventral
mesentery in this region)
and divides into two parts
• The larger cranial part is the
primordium of the liver, the
smaller caudal part gives rise
to the gall bladder and cystic
duct
• The endodermal cells of the
hepatic bud proliferate and
give rise to hepatic cords and
the epithelial lining of the
intrahepatic portion of the
biliary system
• The hepatic cords anastomose
around the sinusoids derived
from the vitelline veins
• The liver grows rapidly
and in 5th-10th week fills
a large part of the
abdominal cavity
• By 9th week, the liver
forms about 10% of
total body weight
• Initially the right and
left lobes are of the
same size, later right
lobe grows larger
• The liver is completely surrounded by ventral
mesentery except on its upper surface where
it adjoins the diaphragm the bare area of the
liver
–The bare area is demarcated by the reflection
of the peritoneum from the diaphragm as the
anterior (superior) and posterior (inferior)
layers of the coronary ligament. These layers
meet on the right and left to form the right
and left triangular ligaments
• The hepatic cords and the epithelial lining of the
intrahepatic portion of the biliary system are derived
from endoderm
• The fibrous tissue, haematopoeitic tissue and Kupffer
cells are derived from the mesenchyme of the
septum transversum
• The hepatic sinusoids are derived from vitelline veins
• Hematopoeisis begins during the 6th week, giving a
dark colour to the liver
• The hepatic cells begins to form bile during the 12th
week
 Development of the Biliary Apparatus
• The small caudal part of
the hepatic diverticulum
becomes the gall bladder,
and the stalk of the
diverticulum forms the
cystic duct
• The stalk connecting the
hepatic & cystic ducts to
the duodenum becomes
the bile duct, and opens
on the ventral aspect of
the duodenum.
• Later due to rotation of
duodenum, the opening
comes to lie dorsally
• The ducts become
occluded initially, but are
later canalized
• After 13th weeks, bile
entering the duodenum
gives a dark green color
to the intestinal contents
(meconium)
 Development of the Pancreas
• Pancreas begins to appear as
two buds, dorsal and ventral,
from the caudal part of the
foregut (region developing
into duodenum) that grow
within the dorsal and ventral
mesenteries respectively
• The dorsal bud is larger,
appears first and lies cranial to
the smaller ventral bud
• The rotation of stomach and
duodenum carry the ventral bud
dorsally along with the bile duct.
• The ventral bud comes to lie
posterior to the dorsal bud and
later fuses with it and their ducts
anastomose
• Finally the pancreas comes to lie
horizontally along the posterior
abdominal wall in a
retroperitoneal position
• The duct of ventral bud
and distal part of the duct
of the dorsal bud form the
main pancreatic duct that
opens on the major
duodenal papilla
• The proximal part of the
duct of the dorsal bud
often persists as the
accessory pancreatic duct
that opens separately on
the minor duodenal
papilla
Ventral pancreatic duct gives rise to head of pancreas
and uncinate process
Dorsal pancreatic duct gives rise to body and tail of
pancreas
 Histogenesis of Pancreas
• The cellular component develops from endoderm of the
pancreatic buds which forms a network of tubules
• Acini begin to develop early in the fetal period from cell clusters
around the ends of these tubules
• Some cells get separated from the tubules and form the
pancreatic islets
• The connective tissue sheath and interlobular septae develop
from the surrounding splanchnic mesenchyme
• The exocrine function begins after birth, while the endocrine
function begins from 10 to 15 weeks onward
• Glucagon and somatostatin secreting cells differentiate before
the insulin secreting cells. However insulin secretion begins by
10 weeks
 Development of the Spleen
• Spleen develops from the
mesenchyme within the dorsal
mesogastrium
• Begins to develop in 5th week and
attains its shape early in fetal life
• Is lobulated initially but lobules
normally disappear before birth
• Spleen functions as a
hematopoeitic organ until late
foetal life, but is less important in
blood cell formation in adult life
midgut loop: by 5th week, midgut grow rapidly to
form a “U”-shaped loop, its apex connects with
yolk sac by way of the narrow vitelline duct
The superior mesenteric artery runs in the
mesentery of this loop to its apex
The loop has a prearterial (proximal) segment and
postarterial (distal) segment.

1. Vitelline duct (see large arrow)

2. Superior mesenteric artery
3. Stomach
4. Duodenum
5. Cephalic limb of the loop
6. Caudal limb of the loop

The superior mesenteric artery forms the axis of the loop

 Midgut development
• During the 6th week, midgut loop grow rapidly
and passes through the umbilical opening into a
part of the extra-embryonic coelom .
• At this stage the intraembryonic coelom
communicates with the extraembryonic
coelom at the umbilicus.
• The midgut loop comes to lie outside the
abdominal cavity of the embryo. (physiologic
umbilical herniation)
Initially, the loop lies in the sagittal plane, its proximal segment
being cranial and ventral to the distal segment.
By 6-8th week, midgut loop rotates 90 degrees around an axis
formed by the superior mesenteric artery in a
counterclockwise direction, cephalic limb move to the right,
caudal limb to the left
This rotation plays a very important part in establishing the
definitive relationships of various part of the intestine.
The cephalic segment undergoes great increase in length
to form the coils of the jejunum and ileum (loops still
outside the abdominal cavity, to the right of the distal
limb). The coils of the jejunum and ileum (proximal
segment) return to the abdominal cavity. As they do
so, the midgut loop undergoes further 180 degrees
anticlockwise rotation.

When completed, the midgut is rotated 270

degrees counter-clockwise.
NB: Intestine should not be behind the stomach
60
61
 Midgut development
• The cephalic limb develops into the jejunum and most
part of the ileum.
• Jejunum and ileum pass behind the SMA into the left
half of the abdominal cavity. Duodenum comes to lie
behind the artery. The jejunum and ileum occupy the
posterior and left part of the abdominal cavity
• Finally, the caudal segment of the midgut loop returns
to the abdominal cavity.
• It also rotates in an anticlockwise direction. With the
result the transverse colon lies anterior to the SMA ,
and the caecum comes to lie on the right side.
• At this stage the caecum lies below the liver, and an
ascending colon cannot be demarcated
 Midgut development
• Caecal bud is derived from the postarterial segment of the
midgut. The caecum and the vermiform appendix are
formed by the enlargement of this bud. The proximal part
of the caecal bud grows rapidly to form the caecum.
• The distal part of the caecal bud remains narrow and
forms the vermiform appendix.
• The vermiform appendix arises from the apex of the
caecum . The lateral (right) wall of the caecum grows much
more rapidly than the medial (left) wall.
• The point of attachment of the vermiform appendix with
the caecum comes to lie on the medial side
• The caecum remains intraperitoneal, the dorsal
mesentery of the ascending colon fuses to the body wall
and the transverse colon remains suspended by the
transverse mesocolon.
 Midgut development
---
Midgut development
 6 weeks
Rotation of midgut loop
- Counterclock wise 90

10 weeks

Retum of midgut to abdomen

11 weeks
 Midgut development
caudal limb: terminal part of ileum, caecum,
vermiform appendix, 2/3 transverse colon
Ascending colon develops from the segment of the
midgut loop distal to the caecal bud.
The right 2/3rd of the transverse colon develop
from the postarterial segment of the midgut
loop.
 Development of the hindgut
• As the midgut loop returns to the abdominal
cavity, the hindgut swings on its dorsal
mesocolon across to the left.
• The mesocolon fuses with the parietal
peritoneum of the left paravertebral gutter
• At the pelvic brim fusion is incomplete and
part of the dorsal mesocolon remains free as
the sigmoid mesocolon.
 Development of the hindgut
• The allantois appears at about 16 days as
a small diverticulum projecting from the
caudal end of the yolk sac into the
connecting stalk
• The urorectal septum, a transverse ridge,
separates the hindgut from the allantois.
It grows towards the cloacal membrane. It
allantois
is derived from mesoderm at the junction
between the connecting stalk and yolk
sac.
• 26 days: After formation of the tail fold,
the allantois and hind gut open into a
common chamber the cloaca.
• The cloacal membrane separates cloaca
from the proctodaeum.
 Development of hindgut
• During the 7th week the cloacal
membrane disappears, exposing a
ventral urogenital sinus opening
and a dorsal anal opening.
• The tip of the urorectal septum,
separating the two openings forms
the perineal body.
• The urorectal septum grows
towards the cloacal membrane but
does not fuse with it. It is derived
from mesoderm at the junction Urogenital sinus
Anal opening
between the connecting stalk and
yolk sac. urorectal septum
 Development of the hindgut
The Anal Canal
•At the end of the 8th week, after
rupture of the cloacal membrane,
proliferation of ectoderm
occludes the anal opening.
•During the 9th week the opening is
recanalized.
•The terminal part of the anal
canal is ectodermal in origin and
supplied by the inferior rectal
artery.
•The junction between ectoderm
and endoderm is the pectinate
line.
Partition of cloaca
 FIXATION OF THE GUT
• At first all parts of the small and large intestines have a
mesentery by which they are suspended from the posterior
abdominal wall.
• After rotation and continued growth of the gut, the
duodenum, the ascending colon, the descending colon and
the rectum become retroperitoneal (by fusion of their
mesenteries with the posterior abdominal wall).
• The original midgut mesentery persists as: the mesentery of
small intestine, and the transverse mesocolon .
• Fixation of the hindgut: when the mesentery fuses with the
peritoneum of the left dorsal abdominal wall and then
disappears posteriorly, the descending colon becomes
retroperitoneal
– THE MESENTERY OF THE SIGMOID COLON, however, persists,
although diminished
 CONGENITAL OBSTRUCTION
• This may be due to a variety of causes.
• Atresia (interference with continuity of the lumen;
a segment of the gut may be missing, replaced by
fibrous tissue, or by a septum blocking the lumen
• Stenosis (abnormal narrowing) .
-Abnormal thickening of muscular wall (congenital
pyloric stenosis)
- External pressure by abnormal band or abnormal
blood vessels (bands seen in relation to the
duodenum or compressed by annular pancreas)
• Imperforate anus (caused by stenosis or atresia of
the lower part of the rectum or anal canal).
atresia or stenosis of digestive tract: caused by
failure of recanalization or improper
recanalization, mostly in esophagus and
duodenum
 Congenital defects of the stomach

• Pyloric stenosis: narrowing of the pyloric antrum

due to smooth muscle hypertrophy of the pyloric
sphincter
 Congenital anomalies of duodenum
• Duodenum atresia
• Duodenum stenosis
 Gut atresias and stenosis can result
from blood vessel occlusion
• Vascular injuries
can cause major
developmental
problems.

84
 congenital malformations of the
digestive tract
• abnormal communication or fistula: Fistula is an
abnormal communication with other cavities or with
the surface of the body. Fistulae are most frequently
seen in relation to the oesophagus and the rectum and
usually associated with atresia of the normal passage.

• duplication
Varying length of the intestinal tract may be
duplicated. The duplication may form only a small cyst,
Or may be of considerable length. It may or may not
communicate with the rest of the intestine.
congenital malformations of the digestive tract

atresia of the gall bladder and bile ducts:

results from failure of vacuolization of the
epithelial cords or reopen
-Non-development of nerve plexuses in the
wall of a part of the intestinal tract.
(megacolon or Hirschsprung’s disease)
 congenital malformations of the
digestive tract
ERRORS OF ROTATION
•Non-rotation of the midgut loop. (small intestine lies
towards the right side of the abdominal cavity, and
the large intestine towards the left).
•Reversed rotation (the transverse colon crosses
behind the SMA and the duodenum crosses in front of
it).
•Non-return of umbilical hernia; Omphalocoele or
exomphalos (herniated parts are covered only by
omentum).
•Congenital umbilical hernia (muscle layer and skin
are absent in the region of the umbilicus, creating a
defect).
Nonrotation of midgut Mixed rotation and volvulus Reversed rotation

Internal hernia Midgut volvulsu

congenital umbilical hernia: caused by
incomplete closure of the central part of
the abdominal wall, the viscera return to
the abdomen but herniated again during
the fetal period
 congenital malformations of the
digestive tract
• DIVERTICULA A gut diverticulum is an
outpouching of the wall of the gut to form a
sac.
Diverticula may arise from any part of the gut.
Diverticula are most common in and near the
duodenum pylorus, fundus of stomach)
• Meckel’s diverticulum; Persistence of vitello-
intestinal duct. It is of surgical importance.
 Meckel Diverticulum
 This outpouching is one of the most common
anomalies of the digestive tract

 This congenital ileal diverticulum occurs in 2 to

4% of people

 3 to 5 times more prevalent in males than

females

 It sometimes becomes inflamed and causes

symptoms that mimic appendicitis
 Meckel Diverticulum
 The wall of the diverticulum contains all layers of the
ileum and may contain small patches of gastric and
pancreatic tissues

 The gastric mucosa often secretes acid, producing

ulceration and bleeding

 It is the remnant of the proximal part of the yolk stalk

 It typically appears as a fingerlike pouch about 3 to 6

cm long
 Meckel Diverticulum

 It arises from the antimesenteric border of the

ileum 40 to 50 cm from the ileocecal junction

 It may be connected to the umbilicus by a

fibrous cord or an omphaloenteric fistula
 congenital malformations of the
digestive tract
• ERRORS OF FIXATION Volvulus; where parts of
intestine, that are normally retroperitoneal,
may have mesentery.
• Adhesion; where parts of intestine, which
normally, have a mesentery, may be fixed by
abnormal peritoneal attachment.
• Sub-hepatic caecum, or may descend only to
the lumbar region. Alternatively, it may
descend into the pelvis.
 congenital malformations of the
digestive tract
SITUS INVERSUS
• All the abdominal and thoracic viscera are
laterally transposed. All parts normally on the
right side are seen on the left side, and vice
versa. For example, the appendix and
duodenum lie on the left side and the
stomach on the right side.
congenital malformations of the digestive tract

congenital aganglionic megacolon: results

from the absence of ganglion cell of the
parasympathetic ganglia, which cause
failure of the distal segment to move the
intestinal contents onward
Urorectal septal partition failure
Langman’s

100
---rectal atresia: due to a failure of the anal pit to
develop or deviation of the urorectal septum in
dorsal direction
---rectal fistula: associate with an imperforate anus,
between the rectum and the vagina or urinary
bladder or urethra
imperforate anus, rectal atresia and rectal
fistula:
---imperforate anus: results from failure to
rupture of the anal membrane
 肛門會陰瘻管

直腸陰道瘻管

直腸尿道瘻管
THE END