Cho Baik Hwan, Kim Ji Hyun, Jin Zhe Wu, Wilting Joerg, Rodríguez-Vázquez José Francisco, Murakami Gen
Emeritus Professor of Chonbuk University, Jeonju, Korea.
Department of Anatomy, Seonam University College of Medicine, Namwon, Korea.
Clin Anat. 2018 May;31(4):583-592. doi: 10.1002/ca.22996. Epub 2017 Nov 28.
Because most malrotations of the small intestine are thought to occur during repackaging, the location of the intestine should vary less during physiological herniation than afterward. Examination of serial sagittal sections of 27 embryos and fetuses (gestational age 6-9 weeks; crown-rump length 15-45 mm) during herniation showed that the jejunum and ascending colon passed through a small opening of the hernia sac at the levels of the stomach and pancreas in 16 specimens. Below the pancreas, a definite mesentery extended between the ascending and descending colon in the abdominal cavity. In the other 11 specimens, the descending colon passed through an opening of normal size and ran posteriorly along the urinary bladder, so the entire ilium, ascending colon, and transverse colon entered the sac. In these specimens, the duodenojejunal junction was usually situated in a window of the mesentery of the colon (internal herniation). The descending colon was observed at an outside location more frequently in earlier specimens. In contrast to our working hypothesis, the locations of the intestine were abnormal in 40.7% (11/27) of samples. In addition, no abnormal colon was observed in any of the seven specimens after repackaging. An outside location of the descending colon was not directly associated with malrotation because recovery was likely. However, the delayed development of the inferior mesenteric arterial branches could cause failure, including death in utero, during or after the repackaging associated with physiological herniation. Clin. Anat. 31:583-592, 2018. © 2017 Wiley Periodicals, Inc.
由于大多数小肠旋转不良被认为发生在重新包裹期间，因此在生理性疝形成期间肠道的位置变化应比之后更小。对27个胚胎和胎儿（孕龄6 - 9周；顶臀长度15 - 45毫米）在疝形成期间的连续矢状切片检查显示，在16个标本中，空肠和升结肠在胃和胰腺水平穿过疝囊的一个小开口。在胰腺下方，腹腔内升结肠和降结肠之间有明确的肠系膜延伸。在其他11个标本中，降结肠穿过正常大小的开口并沿膀胱后方走行，因此整个髂骨、升结肠和横结肠进入囊内。在这些标本中，十二指肠空肠交界处通常位于结肠系膜的一个窗内（内疝）。在较早的标本中，降结肠位于外侧的情况更常见。与我们的工作假设相反，40.7%（11/27）的样本中肠道位置异常。此外，在重新包裹后的7个标本中均未观察到异常结肠。降结肠位于外侧与旋转不良无直接关联，因为恢复是可能的。然而，肠系膜下动脉分支发育延迟可能导致与生理性疝形成相关的重新包裹期间或之后出现包括子宫内死亡在内的失败情况。临床解剖学。31:583 - 592，2018。©2017威利期刊公司。
