[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Embryology](https://durgical.com/en/embryology/) › [Digestive system](https://durgical.com/en/embryology/#a-digestive) › Foregut: esophagus, stomach rotation and duodenum [Embryology](https://durgical.com/en/embryology/) · [Digestive system](https://durgical.com/en/embryology/#a-digestive) # Foregut: esophagus, stomach rotation and duodenum - Process The esophagus splits from the trachea, the stomach turns and the duodenum curls into a C: three steps behind several newborn malformations. Updated 2026-11-01 **See it in 3D:** [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/) · [Stomach](https://durgical.com/en/anatomy/stomach/) · [Duodenum](https://durgical.com/en/anatomy/duodenum/) · [Lesser omentum](https://durgical.com/en/anatomy/lesser-omentum/) · [Vagus nerve](https://durgical.com/en/anatomy/vagus-nerve/) · [Celiac trunk](https://durgical.com/en/anatomy/celiac-trunk/) ## Key points - Week 4: the respiratory diverticulum buds from the ventral foregut wall and the tracheoesophageal septum separates it from the esophagus. - The stomach rotates 90° clockwise around its longitudinal axis: its left side becomes anterior and its right side posterior. - Because of that rotation the left vagus supplies the anterior surface of the stomach and the right vagus the posterior surface. - Faster growth of the dorsal wall forms the greater curvature; the ventral wall becomes the lesser curvature. - Except for its first part, the duodenum becomes secondarily retroperitoneal when its mesentery fuses with the posterior wall. - The duodenal lumen is plugged by epithelial proliferation and then recanalizes; if it does not, atresia or stenosis results. ## What it is The thoracic and abdominal foregut forms the esophagus, the stomach and the first half of the duodenum. The tracheoesophageal septum separates the esophagus from the respiratory diverticulum; the stomach dilates and rotates; the duodenum bends into a C, lies against the posterior wall and passes through a stage with its lumen plugged. Failures of these steps produce tracheoesophageal fistula, duodenal atresia and other exam-favourite malformations. ## Key facts - The muscle of the upper esophagus is striated and that of the lower esophagus is smooth; both receive vagal fibres. - The dorsal mesogastrium follows the rotating stomach and forms the greater omentum; the ventral mesogastrium forms the lesser omentum. - The duodenum receives branches of both the celiac trunk and the superior mesenteric artery because it joins the end of the foregut to the start of the midgut. ## Step by step - Week 4: the foregut caudal to the pharynx divides into a ventral respiratory tube and the dorsal esophagus. - The esophagus starts short and lengthens as the heart and lungs descend. - Week 4: a spindle-shaped dilation of the foregut marks the future stomach. - The stomach turns 90° clockwise around its longitudinal axis, and its dorsal wall grows faster than the ventral wall. - A second turn around the anteroposterior axis moves the pylorus to the right and upward, and the cardia to the left and downward. - The duodenum forms a C-shaped loop that swings to the right as the stomach rotates and settles against the posterior wall. - In the second month its lumen is plugged by epithelial proliferation and recanalizes shortly afterwards. ## Markers - SOX2 - NKX2-1 ## Clinical notes - Failure of the tracheoesophageal septum: esophageal atresia with or without fistula; polyhydramnios and drooling at birth. - Failure of duodenal recanalization: duodenal atresia with the double bubble sign. - Hypertrophy of the pyloric muscle (not a failure of formation): projectile vomiting a few weeks after birth. - An esophagus that stays too short: part of the stomach remains in the chest (congenital hiatal hernia). ## Memory aid Turn the stomach like the page of a book flipped to the right: the left face ends up in front, and the left vagus comes along with it. ## Test yourself Think of the answer, then tap the question to see it. ## Why does the left vagus nerve end up on the anterior surface of the stomach? Because the stomach rotates 90° clockwise around its longitudinal axis, so its original left side becomes anterior. ## What structure separates the esophagus from the trachea? The tracheoesophageal septum, formed by fusion of the tracheoesophageal folds of the foregut. ## Which parts of the duodenum become retroperitoneal? The second, third and fourth parts, when their dorsal mesentery fuses with the posterior wall; the duodenal bulb stays largely intraperitoneal. ## Which malformation results from failed recanalization of the duodenum? Duodenal atresia or stenosis, with early vomiting and the radiographic double bubble sign. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/embryology/foregut-esophagus-stomach-rotation-and-duodenum/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/) - [Stomach](https://durgical.com/en/anatomy/stomach/) - [Duodenum](https://durgical.com/en/anatomy/duodenum/) - [Lesser omentum](https://durgical.com/en/anatomy/lesser-omentum/) - [Vagus nerve](https://durgical.com/en/anatomy/vagus-nerve/) - [Celiac trunk](https://durgical.com/en/anatomy/celiac-trunk/) ## Related - [Primitive gut: foregut, midgut and hindgut and their arteries](https://durgical.com/en/embryology/primitive-gut-foregut-midgut-and-hindgut-and-their-arteries/) - [Lung development: the five stages](https://durgical.com/en/embryology/lung-development-the-five-stages/) - [Esophageal atresia and tracheoesophageal fistula](https://durgical.com/en/embryology/esophageal-atresia-and-tracheoesophageal-fistula/) - [Duodenal atresia and stenosis](https://durgical.com/en/embryology/duodenal-atresia-and-stenosis/) - [Hypertrophic pyloric stenosis](https://durgical.com/en/embryology/hypertrophic-pyloric-stenosis/) - [Mesenteries, the omental bursa and the spleen](https://durgical.com/en/embryology/mesenteries-the-omental-bursa-and-the-spleen/) - [Liver, gallbladder and pancreas](https://durgical.com/en/embryology/liver-gallbladder-and-pancreas/) ## Related conditions - [Hiatal hernia](https://durgical.com/en/conditions/hiatal-hernia/) - [Infantile hypertrophic pyloric stenosis](https://durgical.com/en/conditions/infantile-hypertrophic-pyloric-stenosis/) [← All of embryology](https://durgical.com/en/embryology/) Educational content on embryonic development; not a guide to prenatal diagnosis or to medicines in pregnancy and no substitute for a health professional's advice. No doses are given. Sources: [Embryology, Gastrointestinal](https://www.ncbi.nlm.nih.gov/books/NBK537172/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Anatomy, Abdomen and Pelvis, Peritoneum](https://www.ncbi.nlm.nih.gov/books/NBK534788/) (StatPearls Publishing (NCBI Bookshelf), 2023); Langman's Medical Embryology, 13th ed., ch. 15: Digestive System (Wolters Kluwer, 2015). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/embryology/foregut-esophagus-stomach-rotation-and-duodenum/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/embryology/foregut-esophagus-stomach-rotation-and-duodenum/