Umbilicus and the rectus sheath: a study using human fetuses

Abstract

Purpose The newborn umbilicus is provided by a fibrous ring after closure with a scar at the bottom. Since it is believed to be embedded in the linea alba, a specific connection with the rectus sheath was not yet hypothesized for the umbilicus. However, there are no or few descriptions about the development and growth.

Methods We histologically examined 28 fetuses at 8–40 weeks: 6 fetuses at 8 weeks, 12 at 10–14 weeks and 10 at 31–40 weeks.

Results An initial rectus sheath issued a linear mesenchymal condensation toward the umbilical cord at 10–14 weeks and, an established sheath provided a fibrous band around the umbilical cord at 31–40 weeks. The rectus sheath margins made an acute turn toward the skin at the superior and lateral rims of umbilicus and dispersed into a loose tissue of the cord. In contrast, the sheath margin changed its direction gradually to the superficial side at the inferior rim and inserted at a border between the skin epidermis and a mesothelium-like covering of the cord. The developing umbilical ring contained no or few elastic fibers.

Conclusion Instead of the underdeveloped linae alba, the rectus sheath seemed to be tightly connected with the umbilicus at birth. Rather than an expected elasticity, the rectus muscle contraction was likely to play a critical role in the closure after birth. Via the umbilical ring, the fetal rectus sheath also seemed to tightly connect with the skin at the inferior rim of umbilicus.