Embryology

Development of the Body Cavities

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In the ranking of most popular study subjects among students, embryology is

often near the bottom. In exams, the (admittedly) rare questions on the field
can allow the student to shine by knowing only a limited number of facts, and,
on a normal day in the clinic, symptoms and malformations stemming from this
developmental period are hardly uncommon so it is indeed worthwhile looking
into the details of this field, and not just for aspiring pediatricians. This article
explains the most important facts about the development of the body cavities
and the relevant symptoms.

Human Body Cavities

The two small spaces known as the pericardial and pleural cavities (cavitas
pericardialis and pleuralis), which house the heart and lungs respectively, and the
larger peritoneal cavity (cavitas peritonealis), in which the majority of the abdominal
organs are located, are called the human body cavities. The body cavities are covered
with a serous membrane (tunica serosa).

Picture: “Dorsal and Ventral Body Cavities” by philschatz. Licence: CC BY 4.0

The body cavities of a growing child develop in the embryonic period, during the fourth
to eighth week of development (to remember this: early development 1st-3rd, embryonic
period 4th-8th, and fetal period 9th-38th week of development).
Before the third week of pregnancy, the trifoliate germinal disc is present with the
three blastodermic layers (ectoderm, mesoderm, endoderm: the variously differentiated
precursor cells) as a smooth embryonic disc, and the extraembryonic cavities
(amniotic cavity and yolk sac) are already developed.

Picture: “Development of the Embryonic Disc” by philschatz. Licence: CC BY 4.0

At the end of the embryonic period, the embryonic tissue is separated from the
extraembryonic tissue. At this time, at the end of the eighth week, the shape of the body
is already recognizable and nearly all organs are in their proper place.

On incredibly rare occasions, the following facts are covered in the preliminary medical
exam, and, for oral exams as well, you should only study these thoroughly if you have
enough time or indications of the relevance hereof for the examiner. However, in order to
understand the important symptoms resulting from these processes, everybody should
have heard them at least once. They will be relevant in clinical studies at the latest.

Development of the Trunk Wall

In the fourth week of development, two crucial developmental steps lead to the thoracic
and abdominal wall – and thus the bodily form of the embryo – forming: the lateral
folding (rolling) and the craniocaudal folding of the embryo. Both processes are
caused by the significant growth of the neural plate and the formation of the neural
tube.

One simple example helps visualize this: the C-shaped growth of the embryo results in a
shape that resembles a mushroom. The edges of the mushroom’s hood roll inward and
grow medially, until the right and left sections merge into a sort of sphere.

At the same time, the enclosures for the heart (heart plate) and the septum
transversum (the eventual diaphragm) move into the sagittal plane, the middle of the
embryo. The initially cohesive body cavity forms for the first time: the intraembryonic
coelom (Gr. koilom = hollow space). Through this coalescence, hollow spaces have
formed in the intraembryonic mesoderm that will eventually form the body cavities.

Now a part of the intraembryonic, lateral plate mesoderm cells (do not get confused
by the many word constructions: these are simply the rows of cells surrounding the
mesoderm, sort of like the edge) is in contact with the ectoderm and is now called the
somatopleura. The cell layer bordering the enteroderm is called the splanchnopleura.
The septum transversum (the eventual diaphragm) forms at the crossover point
between the two.

Separation of the Thoracic and Abdominal Cavities

and Development of the Diaphragm
The diaphragm forms in the sixth to eighth week of development via the coalescence of
the septum transversum and the plicae pleuraperitoneales.

Picture: “Muscles of the Diaphragm” by philschatz. Licence: CC BY 4.0

The septum transversum grows ventrally between the heart and the liver enclosure
and into the body cavity, i.e. into the intraembryonic coelom. The pleuropericardial folds
(plicae pleuraperitoneales) grow against it from the anterior, lateral trunk wall. Toward
the end of the eighth week of development, these sections have coalesced to become the
diaphragm, and the thorax and abdomen are spatially separated.

The muscles of the diaphragm first develop during the fourth month of pregnancy –
precursor muscle cells from the anterior, lateral trunk wall inhabit them. The innervation
of the diaphragm by the n. phrenicus is also easy to explain: during the embryonic
period, the diaphragm moves in a caudal direction. During this descent, it simply takes
the ventral branches of the cervical nerves CE – C5 with it.
Note: Memorise the innervation of the diaphragm. This is often covered in exams.

Congenital Diaphragmatic Hernias

Picture: “Congenital right sided diaphragmatic hernia

in a neonate – chest X-ray” by Kinderradiologie
Olgahospital Klinikum Stuttgart. Licence: CC BY-SA
4.0

Congenital diaphragmatic hernias appear in one out of every 10,000 births on average.
By definition, they result in a displacement of abdominal organs (stomach, intestine) into
the chest cavity via gaps in the diaphragm.

The most common congenital hernia is the Bochdalek hernia (95%). Its hernial orifice is
almost always around the left trigonum lumbocostale. However, this weak point may
also appear on the right, although it is effectively “sealed” by the liver on top of it.

The far less common Morgagni hernia (5%) appears in the right trigonum
sternocostale.

Intestinal loops that have migrated into the thorax (referred to as an enterothorax) can
lead to displacement and compression of the heart and lungs, depending on the size.
Children afflicted exhibit respiratory failure, the chest cavity may be asymmetrically
curved, and the stomach may be partially shrunken due to the missing ‘contents’. Any
peristaltic sounds may be auscultated via the thorax, and air-filled intestinal loops (white)
may be visible above the diaphragm in X-ray images.

A diaphragmatic hernia may be visible during pregnancy via ultrasound – this is a

neonatological emergency. Large hernias may result in insufficient space in the chest
cavity, leading to underdevelopment (hypoplasia) of the lungs and its supplying vessels.

Formation of the Pericardial and Pleural Cavity

The first, primitive pericardial cavity forms from fissures in the mesenchyme during
the fifth week of development. At first, it is still connected to the peritoneal cavity via
the canales pericardioperitoneales, as the diaphragm is not yet sealed.
At the same time, the respiratory buds grow in a dorsomedial direction from the root of
the lung to the left and right into these two cavities, and their edges form the primitive
pleural cavity. The primitive pleural cavity is lined by the aforementioned
splanchnopleura (pleura parietalis), and the somatopleura (pleura visceralis)
surrounds the developing lungs.

The two cavities are ultimately entirely separated by the protruding plicae
pleuropericardialis, which ultimately coalesce into the membrana
pleuropericardialis, which, in turn, merges with the root of the lung at the end of the
embryonic period (eighth week).

Formation of the Abdominal Cavity

The abdominal cavity also forms during the aforementioned changes in the embryo.
Through the craniocaudal folding of the embryo, a small part of the adjacent yolk sac
begins obtains an intraembryonic position and is sealed into a type of tube: the
development of the intestine has begun.

The developing intestine lying in the simple body cavity (intraembryonic coelom) is
stretched out by the great growth in length, so that an anterior and posterior
intestinal portal form, between which there still exists a connection to the yolk sac,
located outside of them: the omphalomesenteric duct (ductus omphaloentericus,
ductus vitellinus).

This plays a role in the physiological umbilical hernia and the formation of the umbilical
cord. In addition, it may persist in adults, albeit rarely, as a so-called Meckel’s
diverticulum on the small intestine.

Note: The intestinal tube is formed by intraembryonic segments of the yolk sac.

The growing intestine is divided into a foregut, midgut, and hindgut. The foregut will
later form the stomatodaeum, i.e. the beginning of our gastrointestinal system, and is
sealed by the buccopharyngeal membrane. On the anterior intestinal portal/the
hindgut, the cloacal membrane forms the border with the amniotic cavity.

Physiological umbilical hernia – a crucial step during

development
The rapid growth of the midgut leads to a lack of space in the situs of the embryo. That is
why a hernial sac with intestinal loops and vessels (the eventual a. mesenterica
superior) moves into the extraembryonic coelom (also umbilical coelom) during the
eighth to eleventh week of development. The segments of the intestine continue to grow
within this, and eventually turn on the axis of the vessels (to be precise: once at 270
degrees counter-clockwise).

The individual intestinal segments are now located together in their proper position. Later
in the development, they are relocated back into the body cavity by the length growth of
the embryo. If this step does not occur, the clinical symptoms of an omphalocele (see
below) will arise.

By this point, the aforementioned connection between the U-shaped midgut and yolk sac
still exists: the ductus omphaloentericus (also ductus vitellinus or omphalomesenteric
duct). This virtually ‘pulls’ the intestinal loops out, and, upon further development, it
becomes narrow and sealed. After the intestine has returned to the situs, this duct
becomes a structural part during the formation of the umbilical cord.

The omphalomesenteric duct can also be important for adults: a Meckel’s diverticulum
may remain in the event of poor regression. If the intestine is not completely withdrawn
into the body during the physiological umbilical hernia, the result may be clinical
symptoms of an omphalocele, and intestinal loops may be found outside the child’s
body during birth (see below).

Development of the mesenteries and division of the

peritoneal cavity
The intestine located within the body must also be fixed in the abdomen – the
mesenteries fulfil this function. The midgut initially has two mesenteries on its upper
segments (mesenterium ventrale and dorsale), which connect the intestinal tube with
the anterior and posterior wall of the peritoneal cavity.

Picture: “Regions and Quadrants of the Peritoneal Cavity” by philschatz. Licence: CC BY 4.0

The upper segment of the peritoneal cavity is divided into a right and left section by
these mesenteries during development. Namely, the caudal part of the esophagus, the
stomach and the upper duodenum form from this upper part of the midgut.

The lower section of the intestine is merely held in place by a mesenterium

dorsale; this results in a single cavity in the lower part of the peritoneal cavity, which the
dorsally fastened intestinal tube reaches into.

Malformations in the Development of the Body

Cavities
 Picture: “Omphalocele-Drawing” by Centers for Disease Control
and Prevention. Licence: CC BY-SA 3.0

The omphalocele
Should the intestinal loops fail to return to the developing body after the physiological
umbilical hernia, a portion of the abdominal viscera may remain in a hernial sac in the
umbilical cord. This is referred to as an omphalocele or an umbilical cord hernia.

In most cases, these are parts of the small intestine and/or the liver. A persistent
umbilical hernia can already be diagnosed during pregnancy via sonography. Due to
the high risk of infection, affected children should be surgically treated immediately after
birth.

In the event of an umbilical cord hernia, other malformations are present in 40% of cases,
often right lateral laparoschisis (abdominal wall defect). This means that abdominal
organs are protruding from the right side of the body, are uncovered and usually infected,
and careful operation is imperative.

Picture: “Laparochisis Sagittal View” by X.Compagnion. Licence:

CC BY-SA 2.5

With gastroschisis, the abdominal organs are protruding from the midline. The cause for
this remains unclear. One possibility that has been discussed is that the hernial sac
bursts during the physiological umbilical hernia and the abdominal organs are
subsequently left suspended in the amniotic fluid.

If a great amount of the intestine is outside the abdominal cavity, or if the child has a
very small abdomen, it is possible to first tend to the intestinal loops with a sterile
plastic bag. This is then placed over the child’s stomach so that gravity slowly draws the
intestinal loops back into the abdomen. The gap in the abdominal wall is then surgically
sealed.
Meckel’s diverticulum

Picture: “Meckel-Divertikel” by Milliways. Licence:

CC BY-SA 3.0

A protrusion of the small intestinal wall may remain on the individual as a remnant of the
omphalomesenteric duct. This is the case for 1 or 2% of the population, more
frequently men.

Due to the embryonically early formation of the omphalomesenteric duct, the Meckel’s
diverticulum (as its remnant) usually not only receives intestinal mucous – in over 50%
of cases, gastral mucous cells, cells from the large intestine and cells from the pancreas
are also possible.

Generally, a Meckel’s diverticulum is located 50 to 75cm proximal to the junction of the

ileum to the caecum. In most cases, such a diverticulum remains asymptomatic – in the
event of inflammation, however, it may result in gastrointestinal bleeding and
peritonitis, and the patients exhibit colicky pain and symptoms similar to inflammation
of the appendix (appendicitis).

A Meckel’s diverticulum is removed surgically. If there is any suspicion of appendicitis,

and no intraoperative indication of an inflammation of the appendix, the surgeon must
always inspect the ileum for a Meckel’s diverticulum.

Tip: Due to the dearth of technical terminology, it is difficult for most students to study
embryology. However, most terms are Greek or Latin in origin. Google the translation to
better understand the terminology; this applies to many medical terms but is especially
helpful here.

You can learn more about embryology in the Lecturio course on general and special
embryology from Dr. Steffen-Boris Wirth, M.D. or on the page embryology.ch of the
Universities of Fribourg, Lausanne, and Bern.

Review Questions
The solutions can be found below the references.
1. What is an omphalocele?

A. A persisting ductus omphaloentericus

B. A hernial sac with abdominal viscera in the umbilical cord
C. An eversion of the intestinal wall
D. The connection between the pleural and pericardial cavities
E. A defect of the abdominal wall in the newborn with emergent, bare intestinal loops

2. Which period during pregnancy is referred to as the embryonic period?

A. 1st – 3rd week

B. 3rd – 9th week
C. 4th – 8th week
D. 9th – 38th week
E. 38th – 40th week

3. Where is a so-called Meckel’s diverticulum most commonly found?

A. The stomach
B. The duodenum pars inferior
C. The ileum
D. The transverse colon
E. The esophagus

References
LIU, H. M. (1981). Embryological Development. Biology and Pathology of Nerve Growth,
1-52. doi:10.1016/b978-0-12-452960-1.50006-9

Moore, K. L., Persaud, T. V., & Torchia, M. G. (2013). The developing human: Clinically
oriented embryology.

Normal and Abnormal Embryological Development. (1967). doi:10.17226/20695

Sadler, T. W., &Langman, J. (2006). Langman’s medical embryology. Philadelphia, PA:

Lippincott Williams & Wilkins.

Correct answers: 1B, 2C, 3C

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Notes