It has been established by means of the methods of an anatomical research that a
ring-shaped form is typical of the duodenum during the perinatal period. Starting from the 7th  month of the intrauterine development the tissue layers of the duodenal wall are clearly differentiated. Two periods of an accelerated development (months 5 and 8-10) and a period of a slowed down development (months 6-7) are characteristic of the duodenum throughout the perinatal period

Akhtemiichuk, Yu.T.

Skoreiko, Petro Mykhaylovich

Slobodian, O.M.

Цифровий Репозиторій - Інтелектуальні Фонди Буковинського державного медичного університету

Îðèã³íàëüí³ äîñë³äæåííÿÊë³í³÷íà àíàòîì³ÿ òà îïåðàòèâíà õ³ðóðã³ÿ – Ò. 8, ¹ 2 – 2009 12In recent years researchers concentrate theirattention on the diagnosis and treatment ofcongenital malformations of the digestiveorgans that require surgical treatment [1, 2].Within the mortality pattern of children withsurgical diseases the share of lethal sequelaereaches 90% [3]. Particular attention is givento timely perinatal diagnostics which permitsto determine a policy of pregnancy manage-ment [4]. An expansion of anatomic investiga-tions of man during the perinatal period ofontogenesis is a bare necessity since numerousdiseases of children and adults are etiological-ly linked with the intrauterine period of thedevelopment [5]. Bibliographical findings, dealing with theconsistent patterns of the structure of the duo-denum during the perinatal period are frag-mentary, not numerous and unsystematic.They deal mainly with a study or the anatomyof the duodenum of a certain age group orembryonal transformations at the early stagesof the development [6-8]. The absence ofpapers, concerning an evaluation of thedynamics of the morphometric parameters ofthe duodenum during the perinatal period de-termine the topicality of the research.This particular research is a fragment of aplanned scientific research of Bukovinian Sta-te Medical University entitled "Sex-age-rela-ted regularities of the structure and topogra-pho-anatomical interrelations of the organsand structures during human ontogenesis. Thespecific characteristics of age and sex-relatedembryotopography" (¹ 0105U002927).The object of the research. To establishstandard and variant anatomy and correlationsof the morphometric parameters of the duode-num during the perinatal period of humanontogenesis.Material and methods. The study was car-ried out on 120 specimens of fetuses and new-born infants in situ, using the methods of mac-romicrodissection, preparation of consecutivemicroscopic sections, roentgenography , mor-phometry. A statistical analysis of the obtainedfindings was carried out by means of comput-erized programs "Statgraphics", "Excel 7.0"and "Statistica".Research results and their discussion. Achronological order of spatio – temporal trans-formations of organs and structures, exerting a© Akhtemiichuk Yu.T., Slobodian O.M., Skoreiko P.M.UDC 611.342.013-07CHARACTERISTICS OF DUODENAL MORPHOGENESIS DURINGTHE PERINATAL PERIODYu.T.Akhtemiichuk, O.M.Slobodian, P.M.SkoreikoDepartament of Anatomy, Topographic Anatomy and Operative Surgery (Head – Prof. Yu.T.Akhtemiichuk)of Bukovinian State Medical University, City of ChernivtsiÎÑÎÁËÈÂÎÑÒ² ÌÎÐÔÎÃÅÍÅÇÓ ÄÂÀÍÀÄÖßÒÈÏÀËÎ¯ ÊÈØÊÈ Â ÏÅÐÈÍÀ-ÒÀËÜÍÎÌÓ ÏÅÐ²ÎÄ² Ðåçþìå. Ìåòîäàìè àíàòîì³÷íîãî äîñë³äæåííÿ âñòàíîâëåíî, ùî òèïîâîþ ôîðìîþ äâà-íàäöÿòèïàëî¿ êèøêè ó ïåðèíàòàëüíîìó ïåð³îä³ º ê³ëüöåïîä³áíà. Ïî÷èíàþ÷è ç 7-ãî ì³ñÿöÿâíóòð³øíüîóòðîáíîãî ðîçâèòêó, ÷³òêî äèôåðåíö³þþòüñÿ òêàíèíí³ øàðè êèøêîâî¿ ñò³íêè.Óïðîäîâæ ïåðèíàòàëüíîãî ïåð³îäó äëÿ äâàíàäöÿòèïàëî¿ êèøêè âëàñòèâ³ äâà ïåð³îäè ïðèñ-êîðåíîãî ðîçâèòêó (5 ³ 8-10 ì³ñÿö³) òà ïåð³îä ñïîâ³ëüíåíîãî ðîçâèòêó (6-7 ì³ñÿö³).Êëþ÷îâ³ ñëîâà: äâàíàäöÿòèïàëà êèøêà, àíàòîì³ÿ, ïåðèíàòàëüíèé ïåð³îä.Îðèã³íàëüí³ äîñë³äæåííÿÊë³í³÷íà àíàòîì³ÿ òà îïåðàòèâíà õ³ðóðã³ÿ – Ò. 8, ¹ 2 – 2009 13syntopic effect on the forming of the topogra-phy and form – building of the duodenum, inparticular, the visceral surface of the liver, thehead of the pancreas, the kidneys, the sigmoidcolon has been traced in the perinatal period ofthe development.Taking into account a marked character ofthe anatomical portions of the duodenum in theperinatal period, the presence of the principal 4forms of the organ has been corroborated byus. The typical form of the duodenum is annu-lar that is observed in 64±5 % of cases. V –(16±1 %) and C – like (11±3 %) forms of thecolon are less common, the least common is aU – shaped variant (8±2 %). With the develop-ment of fetuses the number of cases of the ring– shaped and C – shaped forms decreases, thatof the U – shaped  one increases, whereas theV – shaped form has almost identical percent-ages throughout the perinatal period of ontoge-nesis (Fig 1).A relation to the peritoneum of theanatomical parts of the duodenum throughoutthe perinatal period changes. A retroperitoneallocalization of the duodenum is characteristicof early fetuses (4-5 months), except the upperportion and duodenojejunal flexure. In 6-10month old fetuses and newborns the upper por-tion, the superior and duodenojejunal flexuresare more often located intraperitoneally, theupper third or half of the descending portionand the ascending portion of the duodenum –mesoperitoneally, the rest – retroperitoneally.The skeletotopical projection of the duo-denum in the perinatal period is changeable.The upper portion of the duodenum is dis-placed cranially by one intervertebral spase(inearly fetuses it corresponds to the superiormargin of vertebra Th12, in late fetuses-to theinferior margin of vertebra Th11) the lower partof the duodenum is displaced caudally by theheight of the vertebral body and two interver-tebral spaces up to the level of the L2 vertebra.According to our findings the villi of themucous membrane of the duodenum are clear-ly revealed, starting from the 7th month of thedevelopment.At the end of the 5th month sin-gle primary crypts are observed. The epitheli-um in 6-7 month old fetuses is well developed,representing an enterocyte of a cubical orcylindrical form. Transparent and distributedirregularly goblet cells are located in themucous membrane of 8-10 month old fetuses.The number of cells in the mucous tunic of theduodenum increases with the development offetuses. Starting from the 6th month the prop-er mucous plate of the mucous tunic is wellmarked. The number of blood vessels in thesubmucous layer increases as fetuses develop.Isolated Brunner's glands in the submucous0% 20% 40% 60% 80% 100%4–56–78–10Perinatal period, monthsRing-shaped form V-shaped form C-shaped form U-shaped formFig. 1. Dynamics of changes of the duodenal forms during the perinatal period of ontogenesis.Îðèã³íàëüí³ äîñë³äæåííÿÊë³í³÷íà àíàòîì³ÿ òà îïåðàòèâíà õ³ðóðã³ÿ – Ò. 8, ¹ 2 – 2009 14layer are revealed in 7 month old fetuses whichembrace practically the entire thickness of thesubmucous layer at the end of the fetal period.The circular and longitudinal layers aredifferentiated in the muscular tunic of the duo-denum. If the longitudinal layer in 4-7 monthold fetuses is interrupted sometimes, then it isof almost identical thickness with the circularone in 8-10 month old fetuses (Fig. 2). A fee-bly marked character of the serous tunic of theduodenum is characteristic of 4-5 month oldfetuses, in 6-10 month old fetuses and new-borns it contains a great number of connectivetissue fibers and blood vessels. A fusion of theserous membrane of the duodenum with the glan-dular capsule is observed in the region of a closecontiguity of the pancreas to the duodenum.On the basis of the obtained findings wehave singled out two periods of an accelerateddevelopment of the duodenum (months 5 and8-10) and a period of their slowed down deve-lopment (months 6 and 7). A relatively delayeddevelopment in 6- and 7 month old fetuses isnot intrinsic to all, but only to 50 % of the stu-died morphometric parameters of the anatomi-cal parts of the duodenum.Direct correlation dependencies of theparietocalcaneal length of the body with thediameters and lengths of the body with thediameters and lengths of different anatomicalparts of the duodenum stipulated by an identi-cal speed of the biosynthetic processes of themorphometric parameters of the duodenumand the body as a whole have been establishedthroughout the entire perinatal period.In the process of the research direct corre-lation dependencies between the morphomet-ric parameters of different anatomical parts ofthe duodenum during the perinatal period ofontogenesis point out to a considerable degreeof integration and essential synergism of anaccelerated and slowed down development ofthe structures under study.Conclusions. 1. A typical form of the duo-denum during the perinatal period of humanontogenesis is circular (64±5 %). 2. Histo-structurally the wall of the duodenum at thebeginning of the perinatal period (4-5 months)is characterized by the presence of primarycrypts and the muscle plate of the mucoustunic, a diverse thickness of the layers of themuscular coat; the villi of the mucous mem-brane, goblet cells, Brunner's glands in thesubmucous layer, an almost identical thicknessof the layers of the muscular tunic take shapein the duodenum of 8-10 month old fetuses andnewborns. 3. Two periods of an accelerateddevelopment (months 5 and 8-10) and a periodof a retarded development (months 6-7) areintrinsic to the duodenum during the perinatalperiod.Outlooks of further research. It is expe-dient to determine the topographo-anatomicalcharacteristics of the papillary segment of theduodenum in fetuses and newborns.Fig. 2. A longitudinal section of the duodenal wall ofa fetus 410.0 mm of the parietocalcaneal length. Stai-ning with hematoxylin and eosin. A microscopic speci-men. Ob. 3.5õ, oc. 10õ: 1 – the muscular tunic; 2 – thesuubmucous layer; 3 – the pancreas.References1. Natural history of experimental intestinal atresia: morphologic and ultrastructural study / S.M.Baglaj, J.Czernik,J.Kuryszko [et al.] // J. of Pediatric Surg. – 2001. – V. 36, ¹ 9. – P. 1428-1434. 2. Bueno J. Analysis of patients withlongitudinal intestinal lengthening procedure referred for intestinal transplantation / J.Bueno, J.Guiterrez // J. ofPediatric Surg. – 2001. – V. 36, ¹ 1. – P. 178-183. 3. Äàâèäåíêî Â.Á. Åôåêòèâí³ñòü òà ä³àãíîñòè÷íå çíà÷åííÿÎðèã³íàëüí³ äîñë³äæåííÿÊë³í³÷íà àíàòîì³ÿ òà îïåðàòèâíà õ³ðóðã³ÿ – Ò. 8, ¹ 2 – 2009 15ïðåíàòàëüíîãî äîñë³äæåííÿ ïëîäà ó ïîêðàùåíí³ íàñë³äê³â ë³êóâàííÿ âðîäæåíî¿ ïàòîëîã³¿ òðàâíîãî òðàêòóó ïåð³îä³ íîâîíàðîäæåíîñò³ / Â.Á.Äàâèäåíêî, Â.Â.Â'þí, Í.Ð.Â'þí // Óëüòðàçâóê. ïåðèíàò. ä³àãíîñòèêà. –2005. – ¹ 20. – Ñ. 127. 4. Òîðëîïîâà Â.À. Àëãîðèòì àíòåíàòàëüíîé äèàãíîñòèêè è òàêòèêè ïðè ïîðîêàõ ðàçâè-òèÿ ïèùåâàðèòåëüíîãî òðàêòà / Â.À.Òîðëîïîâà // Äåò. õèðóðãèÿ. – 2006. – ¹ 4. – Ñ. 19-22. 5. Àõòåì³é÷óê Þ.Ò.Íàðèñè åìáð³îòîïîãðàô³¿ / Àõòåì³é÷óê Þ.Ò. – ×åðí³âö³: Âèä. ä³ì "Áóêðåê", 2008. – 200 ñ. 6. Àõòåì³é÷óê Þ.Ò.Åìáð³îòîïîãðàô³÷í³ âçàºìîâ³äíîøåííÿ äâàíàäöÿòèïàëî¿ êèøêè ç îðãàíàìè òà ñòðóêòóðàìè ÷åðåâíî¿ïîðîæíèíè / Þ.Ò.Àõòåì³é÷óê // Òàâðè÷. ìåä.-áèîë. âåñòí. – 2002. – Ò. 5, ¹ 3. – Ñ. 23-25. 7. Ñòàíîâëåíèåòîïîãðàôèè âíóòðåííèõ îðãàíîâ ÷åëîâåêà â ðàííåì ïëîäíîì ïåðèîäå êàê îòðàæåíèå èõ ñòðóêòóðíûõïðåîáðàçîâàíèé / Ë.Ì.Æåëåçíîâ, Ý.Í.Ãàëååâà, Ñ.Â.Ëèñèöêàÿ [è äð.]: ìàòåð. ìåæäóíàð. íàó÷. êîíô., ïîñâ.450-ëåòèþ ãîðîäà Àñòðàõàíè // Àñòðàõ. ìåä. æ. – 2007. – Ò. 2, ¹ 2. – Ñ. 76. 8. Öèâêîâñêèé À.À. Ôîðìûäâåíàäöàòèïåðñòíîé êèøêè ÷åëîâåêà è èõ òîïîãðàôè÷åñêîå ïîëîæåíèå / À.À.Öèâêîâñêèé // Biomedical andBiosocial Anthropology. – 2007. – ¹ 9. – Ñ. 271.ÎÑÎÁÅÍÍÎÑÒÈ ÌÎÐÔÎÃÅÍÅÇÀ ÄÂÅ-ÍÀÄÖÀÒÈÏÅÐÑÒÍÎÉ ÊÈØÊÈ Â ÏÅ-ÐÈÍÀËÜÍÎÌ ÏÅÐÈÎÄÅÐåçþìå. Ìåòîäàìè àíàòîìè÷åñêîãî èññëå-äîâàíèÿ óñòàíîâëåíî, ÷òî òèïè÷íîé ôîðìîéäâåíàäöàòèïåðñòíîé êèøêè â ïåðèíàòàëü-íîì ïåðèîäå åñòü êîëüöåâèäíàÿ. Íà÷èíàÿ ñ7-ãî ìåñÿöà âíóòðèóòðîáíîãî ðàçâèòèÿ, ÷åò-êî äèôôåðåíöèðóþòñÿ òêàíåâûå ñëîè êè-øå÷íîé ñòåíêè. Íà ïðîòÿæåíèè ïåðèíàòàëü-íîãî ïåðèîäà äëÿ äâåíàäöàòèïåðñòíîé êèø-êè õàðàêòåðíî äâà ïåðèîäà óñêîðåííîãî ðàç-âèòèÿ (5 è 8-10 ìåñÿöû) è ïåðèîä çàìåäëåí-íîãî ðàçâèòèÿ (6-7 ìåñÿöû).Êëþ÷åâûå ñëîâà: äâåíàäöàòèïåðñòíàÿ êèø-êà, àíàòîìèÿ, ïåðèíàòàëüíûé ïåðèîä.CHARACTERISTICS OF DUODENALMORPHOGENESIS DURING THE PERI-NATAL PERIODAbstract. It has been established by means ofthe methods of an anatomical research that aring-shaped form is typical of the duodenumduring the perinatal period. Starting from the7th  month of the intrauterine development thetissue layers of the duodenal wall are clearlydifferentiated. Two periods of an accelerateddevelopment (months 5 and 8-10) and a periodof a slowed down development (months 6-7)are characteristic of the duodenum throughoutthe perinatal period.Key word: duodenum, anatomy, perinatalperiod.Bukovinian state medical university (Chernivtsi)Íàä³éøëà 02.03.2009 ð.Ðåöåíçåíò – ïðîô. Ì.Ñ.Ãíàòþê (Òåðíîï³ëü)© Akhtemiichuk Yu.T., Slobodian O.M., Skoreiko P.M.

Characteristics of duodenal morphogenesis during the perinatal period

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Цифровий Репозиторій - Інтелектуальні Фонди Буковинського державного медичного університету