The embryology of body wall closure: relevance to gastroschisis and other ventral body wall defects

Abstract

During the 3rd and 4th weeks post-fertilization (5 and 6 weeks from the last normal menstrual period [LNMP]), the human embryo is transformed from a flat disc-shaped organism into the classic shape of an embryo in the "fetal" position. This change is effected by simultaneously rolling the top layer of the disc, the ectoderm, into the neural tube and the bottom layers of the disc, the endoderm and mesoderm, into the gut tube and body wall, respectively. In this manner, the flat disc is transformed into two tubes, one dorsal to the other, surrounded by supporting structures in the body wall. If closure of the neural tube fails, then neural tube defects (NTDs), such as anencephaly and spina bifida, occur; if closure of the ventral body wall fails, then ventral body wall defects, such as ectopia cordis, gastroschisis, and bladder and cloacal exstrophy, occur. Interestingly, no known closure defects have been described for the gut tube. Note, however, that all of the closure defects that do occur have their origins early in gestation during the third and fourth weeks of development.