MIDGUT

OMISOL, GAY LAURICE C.

• 5 week embryo
- The midgut is suspended from dorsal abdominal wall
By: short mesentery
Communicates with yolksac
by: Vitelline duct or Yolk sac
• Superior Mesenteric Artery
- Supplies the entire length of the midgut
• Characteristics of Midgut development
Rapid elongation of the Gut and its mesentery
Result:
Formation of PRIMARY INTESTINAL LOOP
• Apex loop: Primary intestinal loop
remains open in connection with yolk sac
By: Vitelline duct

• Cephalic limb loop:

develops
1.distal parts of duodenum,
2.the jejenum
3.part of the ileum
• Caudal limb loop:
Becomes
1. Lower portion of the ileum
2. The cecum
3. The appendix
4. Ascending colon
5. The proximal 2/3 of the transverse colon
 Physiological Umbilical Herniation
• 6th week of development
• Rapid growth and expansion of the liver
Due to:
The abdominal cavity
temporarily becomes too small to
contain all intestinal loops enter
the extraembryonic cavity in the
umbilical cord.
 Rotation of the Midgut
• Occurs during:
- herniation
- Return of intestinal loops in
the abdominal cavity
• Rotation: Counterclockwise
• Complete rotation = 270 degrees
During the rotation:
1. Elongation of small intestinal loop continues
2. Jejenum and ileum forms a no. of coiled loops
3. Large intestine lengthens but does not participate
In coiling phenomenon
 Retraction of Herniated loops
• 10th week
• herniated loop begin to return to the abdominal cavity

Important roles:
1. Regression of mesonephric kidney.
2. Reduced growth of liver.
3. Expansion of the abdominal cavity.
 Proximal portion of jejenum
(Retraction of Herniated loops)

• First part to reenter the abdominal cavity

• Lie on the LEFT side.
later returning loops gradually settle more and more to the
RIGHT side.
 Cecal bud
(Retraction of Herniated loops)

• It is a small conical dilation of the caudal limb of the primary intestinal

loop.
• Appear at 6th week.
• Largest part of the gut to reenter the abdominal cavity.
 Cecal bud
(Retraction of Herniated loops)

Lies “Temporarily” in the RIGHT upper quadrant directly below the Right lobe of the liver.

Descends to RIGHT iliac fossa

Placing : Ascending colon and Hepatic flexure
In RIGHT abdominal cavity
• During this process
Distal end of the cecal bud forms = APPENDIX; a narrow diverticulum.
RETROCECAL/ RETROCOLIC - final position of the appendix which is posterior to cecum or colon.
 Mesenteries of the Intestinal loop
• Mesentery Proper
Mesentery of the primary intestinal loop
Undergoes profound changes with the rotation and coiling of the bowel.
• Caudal limb
- Moves RIGHT side of the abdominal cavity.
• Dorsal Mesentery
- Twist around: Origin of SUPERIOR MESENTERIC ARTERY.
 Mesenteries of the Intestinal loop
• Ascending and Descending colon
- obtain definitive positions and their mesenteries press against the
peritoneum of the POSETRIOR abdominal wall.
- after fusion: permanently anchored in PERITONEAL POSISTION.

3 Retain free Mesenteries:

• Appendix
• Lower end of cecum
• Sigmoid colon
 Mesenteries of the Intestinal loop
Transverse Mesocolon
- Fuse with posterior wall of greater omentum
- Maintains mobility
- line of attachment:
extends from hepatic flexure of the ascending colon to
splenic flexure of descending colon.
Jejunoiteal Loop
- First continuous with ascending colon then fuses with
Posterior Abdomnial wall
- New line of attachment:
extends from an area were the duodenum
becomes intraperitoneal to the ileocecal junction.
 Clinical Correlates
Abnormalities of the Mesenteries

Retrocolic Hernia
Entrapment of portions of the small intestine behind the mesocolon.
 Clinical Correlates
Body wall defects
Omphalocele
Involves herniation of abdominal
viscera through an enlarged umbilical ring.

Gastrochisis
Refers to a protrusion of abdominal
contents through the body wall directly into
the amniotic cavity.
 Clinical Correlates
Vitelline Duct Abnormalities

Meckel Diverticulum or Ileal diverticulum

A small portion of the vitelline duct persists forming an outpocketing of the ileum.

Enterocysting or Vitelline cyts

Both ends of Vitelline duct transform into fibrous cords and middle portion forms a large cyst.

Umbilical Fistula or Vitelline Fistula

An abnormality when the vitelline duct remains patent over its entire length forming a direct
communicairton between the umbilicus and the intestinal tract.
 Clinical Correlates
Gut Rotation Defects

Reversed rotations of the intestinal loop.

- Occurs when the primary loop rotates 90 degrees clockwise
- Transverse colon passes behind the duodenum and lies behind the superior mesenteric artery.

Duplications if intestinal loops and cyst.

- occur anywhere along the length of the gut tube.
- frequently in the region of the ileum, where they may form a long segment to a small diverticulum.
 Clinical Correlates
Gut Atresias and Stenosis

Gut Atresias and Stenosis

• May be caused by problems with expression of HOX , FGF and certain FGF receptors during gut
differentiation by vascular accidents
• Upper duodenum lack of recanalization.

Apple Peel Atresia

10%
The atresia is in the proximal jejunum, and the intestine is short with the portion distal to the lesion
coiled around a mesenteric remnant.
END…