EMBRYOLOGY OF APPENDIX As a result of cephalocaudal and lateral folding of the embryo, a portion of the endoderm-lined yolk sac cavity

is incorporated into the embryo to form the primitive gut. Two other portions of the endoderm-lined cavity, the yolk sac and the allantois, remain outside the embryo (see figure 13.1, AD) In the cephalic and caudal parts of the embryo, the primitive gut forms a blind-ending tube, the foregut and hindgut, respectively. The middle part, the midgut, remains temporally connected to the yolk sac by means of the vitelline duct, or yolk stalk. (see figure13.1D)

MIDGUT The derivatives of the midgut are : The small intestine, including the duodenum distal to the opening of the bile duct The cecum, appendix, ascending colon, and right one half to two thirds of the transverse colon These midgut derivatives are supplied by the superior mesenteric artery, the midgut artery (see figure 13.24)

the

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5 week development of the midgut is characterized by rapid elongation of the gut and its mesentery, resulting in formation of the primary intestinal loop (midgut loop) see figure A At its apex, the loop remains in open connection with the yolk sac by way of the narrow vitelline duct The cephalic limb of the loop develops into the distal part of the duodenum, the jejunum, and part of the ileum. The caudal limb becomes the lower portion of the ileum, the cecum, the appendix, the ascending colon, and the proximal two-thirds of the transverse colon. 6 week rapid elongation, particularly of the cephalic limb. as a result of the rapid growth and expansion of the liver, the abdominal cavity temporarily becomes too small to contain all the intestinal loops, and they enter the extraembryonic cavity in the umbilical cord (PHYSIOLOGICAL HERNIATION) 6 12 week rotation of midgut See figure A & B while it is in the umbilical cord, the midgut loop rotates 90 degrees counterclockwise (looking from the ventral side) around the axis of the superior mesenteric artery. (A1 & B1, Illustration of a further rotation of 90 degrees) this brings : o the cranial limb (small intestine) of the midgut loop to the right and o the caudal limb (large intestine) to the left. During rotation, the cranial limb elongates and forms intestinal loops (e.g., primordia of jejunum and ileum). see figure C at approximately 10 weeks, showing the intestines returning to the abdomen (C1, Illustration of a th th

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further rotation of 90 degrees) see figure D at approximately 11 weeks, after return of intestines to the abdomen. (D1, Illustration of a further 90-degree rotation of the gut, for a total of 270 degrees) see figure E Later fetal period, showing the cecum rotating to its normal position in the lower right quadrant of the abdomen.

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During the 10 week the intestines return to the abdomen (herniated intestinal loops) begin to return to the abdominal cavity. Although the factors responsible for this return are not precisely known, it is thought that regression of the mesonephric kidney, reduced growth of the liver, and expansion of the abdominal cavity play important roles. In 6 week appears an elevation on the antimesentric border of the caudal limb of midgut loop : the primordium of the cecum and wormlike appendix-the cecal swelling (diverticulum) figure A The apex of the cecal swelling does not grow as rapidly as the rest of it; thus, the appendix is initially a small diverticulum of the cecum (Figure B) The appendix increases rapidly in length so that at birth it is a relatively long tube arising from the distal end of the cecum (figure D). After birth, the wall of the cecum grows unequally, with the result that the appendix comes to enter its medial side. The appendix is subject to considerable variation in position. As the ascending colon elongates, the appendix may pass posterior to the cecum (retrocecal appendix) or colon (retrocolic appendix). It may also descend over the brim of the pelvis (pelvic appendix). In approximately 64% of people, the appendix is located retrocecally (figure E).
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References : langman embryology 10e, moore develoving human 8e.

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