The Embryology of Gut Rotation

Department of Paediatric Surgery, University Hospital Eppendorf, Germany.
Seminars in Pediatric Surgery (Impact Factor: 2.22). 12/2003; 12(4):275-9. DOI: 10.1053/j.sempedsurg.2003.08.009
Source: PubMed


Until today, the puzzling spectrum of midgut "malrotations" is commonly explained by an "impaired" process of rotation of the midgut. However, a closer look at the literature reveals that the description of this "process of rotation" is rather schematic and is aimed more at explaining pathological findings, while detailed proper embryological investigations are still rare. Despite recent trials, good animals models that would allow the comparison of normal and abnormal midgut development are still missing. In the first part of this article, the "normal process of rotation," as it is described in the literature, is presented and critically analyzed. In general, it is a shortcoming that reliable illustrations of these crucial embryological processes are missing in most of these papers. Therefore, in the second part of this review scanning electron microscopy pictures of the developing midgut are presented in a series of rat embryos. In these pictures clear signs of a process of rotation are missing.

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Available from: Stefan Jaeschke-Melli
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    • "After ten weeks, gut rotation results in the jejunum being positioned in the left side of the abdomen, which is the definitive location [24]. An impaired process of rotation of the midgut results in the so-called malrotation with a right-sided jejunum, usually associated with a superior mesenteric artery on the right side of the superior mesenteric vein (Fig. 1) [24] [25]. "
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    • "To generate the final anatomical configuration of the mature gastrointestinal tract, the PGT undergoes dramatic elongation. In mammals, the midgut elongates so disproportionately that it must protrude into the umbilical stalk as the so-called ''physiological hernia'' (Kluth et al., 2003), before moving back into the visceral cavity during subsequent development. Likewise, the amphibian gut elongates more than three-fold in a single day, packaging its extensive length into concentric coils (Chalmers and Slack, 2000). "
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    • "Reduction and rotation are completed by the tenth week of gestation and result in the prearterial segment localized below and to the left of the SMA while the postarterial segment lies superior and to the right. Lastly, the mesenteries of the ascending and descending colons become fused to the posterior parietal peritoneum, and the root of the small bowel mesentery, containing the SMA, extends obliquely from the left side of the second lumbar vertebra toward the right sacroiliac joint.16,17 "
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