US2324520A - Apparatus and method for closing abnormal openings in wall-like members of the anatomy - Google Patents

Description

, 1943. o. F. LAMSON 2,324,520

APPARATUS AND METHOD FOR CLOSING ABNORMAL OPENINGS IN WALL LIKE MEMBERS OF THE ANATOMY Filed April 7, 1941 July ,20

' INVENTOR,

017s )Z'Lamson 2 lilll I 1 lb Patented July 20, 1943 UNITED STATES: PATENT \OFFICE APPARATUS AND METHOD FOR CLOSI NG ABNORMAL OPENINGS IN WALL-LIKE MEMBERS OF THE ANATOMY Otis F. Lamson, Seattle, Wash. Application April 7, 1941, Serial No. 387,233 I g 2. Claims. My invention relates to a removable dam or blocking member to control the discharge from the bowels," especially for use by a patient who has been subjected to a colostomy.

More particularly, my invention relates to such characterized by forming a seal between an infiated member within the bowels and the inner wall of the intestineby which the intestine is pressed against the body wall.

Due to many circumstances, as abnormal conditions at birth, cancer and other diseases, many colostomies are necessary, 1. e., the colon of the patient is brought out through an opening in the abdomen to provide for the bowels to move through this opening. Such patients of course lose the utility of the intricate and highly complex rectal muscular actions and nervous mechanisms which nature has provided for control of the bowels. While there are a very great number of patients on whom colostomies have been performed, no one heretofore has provided a practical means which may be used by such patients for periodic control, a feature lost because of the nature of the operation performed. At one timeit was considered likely that the colon might be brought out through a stoma leading between said abdominal muscles so that such muscles could be used as a control meansthe stoma, it being understood, being the channel through the body wall through which channel a portion of the intestine is drawn and secured to the outside skin surrounding the exterior opening of the stoma. However, in practice it was found that obstructions of the bowels often resulted, thus bringing about the very condition which was to be eliminated by the colostomy.

Colostomies, as is well known, may be temporary, as for example, when a growth in certain parts of the colon is to be removed, a colostomy may be performed proximal to the growth in order to sidetrack the fecal current until such a time as the growth can be safely resected or removed. After the intestinal anastomosis, where the growth was removed, has

devices, as bandage-pad members or colostomy bags which do not in fact solve the problem incident to the lack of control and in addition often cause irritation and burning of the skin and often personal embarrassment to patients incident to their physical impairments. The inadequacy of prior devices for colostomy control is shown by the fact that even doctors themselves hesitate to subject themselves to permanent colostomies, even though their condition may be such as to urgently require the same.

It is an object of my invention to provide an intestinal-dam or device which may be inserted through the stoma formed as a part, of the colostomy operation and will operate internally. of the intestines. asablocking means for the bowels by causing a pressing by an inflatable member .within the bowels of an annular portion of the intestines adjacent theinterior; opening of the stoma against the body jwallc a l It is a further object of the invention in cases of colostomies toprovide a removable dam or device for .controllably closing the intestines against unintended escape of secretions or gases,

ber within the bowels adapted to assume a shape which resiliently presses that portion of the intestine adjacent the interior opening of the stoma against the peritoneal lining. This pressure draws inwardly the. pad like member sothat the body wall is gently squeezed between said pad and said inflatablemember .to form a backing against which the inflatable member may urge the wall of the intestines.

A further object of my invention is to provide a device having. an inflatable member so that when inflated it will be of a compressed sphere or ellipsoidlike shape.

It is a further object of the invention to provide a device of the class described which is light in weight, maybe readily and quickly inserted or removed by the patient, which may be worn withoutdiscomfort or irritation and where an increase in pressure due to secretions orgas, will servejto augment the blocking or damming characteristics of the dam, thereby further eliminating any possibility of accidental leakage. Also it is my object to provide. such a device that any such increase in pressure of secretions or gases will be felt by the patient, and, be it particularly noted, will thereby serve as a signal to the patient that the time has come for the removal of the device to permit a movement of the bowels. The importance of the positive security of the closing or blocking of the bowels against accidental release may be further realized when it is remembered that the secretions and gases are characterized by obnoxious odors.

It is a further object to provide a device for closing an opening in a wall-like member of a patient, for example as in the case of an opening resulting from a colostomy or an ileostomy and the case of a fistula, wherein a pad member is placed about the opening and adjacent one side of said wall and an inflatable member is connected with said pad member and is placed about the opening and adjacent the other side of said wall and functions upon inflation to press the pad member against one side of the wall and the inflatable member against the other side of the wall.

The above mentioned general objects of my invention, together with others inherent in the same, are attained by the device illustrated in the following drawing, the same being preferred exemplary forms of embodiment of my invention, throughout which drawing like reference numerals indicate like parts:

Figure 1 is a view in side elevation wherein a plurality of layers of tissues are disposed between the internal dam and the external pad member and showing somewhat schematically the intestine being dammed thereby;

Fig. 2 is a longitudinal sectional view of my device with the internal blocking member expanded;

Fig. 3 is a view similar to Fig. 2 with the internal blocking member deflated;

Fig. 4 is a view similar to Figure 1 of a modified form of the invention;

Fig. 5 is a longitudinal sectional view of a further modified form of my invention;

Fig. 6 is a view in longitudinal section illustrating the application to a wall of the intestine of a device of small dimensions embodying my invention to temporarily close a fistula; and

Fig. 7 is a perspective view of a syringe which may be used in this invention.

Referring to Figure 1 of the drawing, the outside skin or epithelium of a patient is represented by the layer I6, the fat tissues by I I, the muscle tissues by I2 and the peritoneal membrane by I3. It is to be understood that the thickness of the various layers II] to I3 forming the body wall will vary with individual patients. Upon performing the colostomy the intestine I4 has been severed from its normal outlet and has been passed through the stoma I5, i. e., the channel through the various layers I0 to I3 forming the abdominal or body wall, and brought to the outer surface as at 9 Where it is secured or permitted to adhere.

Referring to Fig. 3, a rubber inflatable member I 6 is secured to the tubular member I! by binders I8 and I9. The length of the tubular member I! varies for individual patients, depending upon the thickness of the various layers ID to I3, inclusive, of the abdominal wall, so that the rubber internal dam or blocking member I6 will provide gentle pressure directed longitudinally of the tubular member I'I, thus permitting the inflatable or blocking member It to urge the annular portion of the intestine or colon I4 surrounding the interior opening of the stoma gently, but not too firmly so as to cause discomfort but with sulficient pressure to control discharge from the intestine, against the interior of the peritoneum I3 and at the same time to press or draw inwardly the external pad member 26 against the outside skin or tissue In. The tubular member I! is provided with a passageway 2| and a valve member 22. When the internal blocking member I6 is deflated, as shown in Fig. 3, it may be lubricated and inserted through the stoma I5 so that the extent of insertion is that substantially as shown in Fig. 1. The valve member 22 is of usual construction and provides for selective open and closed positions. First the valve 22 is opened and then by any suitable air syringe 3|, such as that shown in Fig. 7, the internal inflatable blocking member I6 is inflated to the necessary extent to provide for blocking of the colon or intestine I4, with a pressure comfortable to the patient and insufiicient to cause irritation. Then the valve 22 is closed to maintain the member I6 inflated. The syringe 3I is preferably provided with a threaded connector 32 to permit the patient to use the syringe as a handle to pull longitudinally the tubular member I! by way of testing to ascertain whether the inflatable member I6 is inflated to the desired degree. Upon proper inflation there will be sufficient pressure on the tissues In to I3, inclusive, between the external pad member 2!! and the internal dam I6,toprovide for a'positive internal blocking of the intestine I4. Upon providing the proper length of the tubular member I7 and proper inflation of the internal dam I6, 2. positive resilient seal is provided between the inflated member I6 and the inside wall of the i.ntestinethe outer wall of 'said intestine being pressed against th peritoneal lining I3 of the body wall, which in turn'is held as a backing by the pad member 26. In this wise counterpressures are developed. At the same timethe device is such that it may be worn with comfort by the patient. Also any secretions or gases in the colon I4 will provide additional pressure against the internal dam I6 and augment the blocking or damrning characteristics of the device. I

In order to facilitate insertion of the device and to better control the inflated shape thereof, 1 provide for securing the inflatable member I6 at two spaced apart locations on an end portion of the tubula member ll, as by the binders I8 and 69 as shown in Figs. 1, 2 and 3 with openings or outlets 25 in the tubular member I'I. Also preferably the inflatable member is provided with thickened portion 23 in Fig. 4 and thickened portion 33 in Fig. 5, so that the same, upon inflation, will readily assume the preferred ellipsoid or compressed sphere like shape shown.

In Fig. 4 of the drawing I have shown an alternative form of construction where an internal inflatable dam member with thickened portion 23 is shown with one wrapping or binding member 24 to secure the inflatable member 34 to the tubular member I'I. As the parts connected with the stem or tubular member I I duplicatethose shown in the previous figures, the stem or tubularv member is shown broken away and numbered H. In this form of the invention the inflatable member 34 is provided with thickened and thinned portions as illustrated in order to assure that it will assume the ellipsoid or compressed sphere, i; e., flattened shape shown in Fig. 4. However, I prefer that the internal inflatable dam member will be secured as shown in Figs. 1, 2 and 3, as this will directly operate to eliminate tendency of the member 16 or 2 3 from in- I bears or presses flating longitudinally of the intestine It as dis tinguished from sidewise or [laterally thereof. The fullest advantages of the invention are realized when the inflatable member is of the preferred ellipsoid or flattened sphere shape, as this will insure greater contact between the intestinal wall and the peritoneal'wall, however theadvantages of this invention will be proportionately realized if the inflatable membe is, sphericalin shape when inflated;

In Fig. a modified form is shown wherein th features of the device shown in Figs. 2 and 4 are combined. That is, the inflatable member is shown with thick wall portions 33 and thin wall portions 21 and also secured to the, tu: bular member IT by two spaced apartbinders 2 3 and 29 todoubly insure the ellipsoid like shape.

In Fig. 6 the device is shown applied to a fistula. In case of a fistula in the intestine it may be desirable to temporarily close the fistula'in a manner to permit the fecal current to be free to flow distal to the fistula in order to learn whether the bowel is obstructed distal to the fistula. The device is of small dimensions to permit insertion through the fistula and the inflatable member 30 being of relatively small size does not objectionably obstruct the fecal current. In this wise, it may be determined whether all that is necessary is simple repair of the fistula or whether there is in fact an obstruction distal to the fistula which also must be corrected in order, to insure a successful closure of the fistula.

It has been found that patients having colostomies may be fitted with a device embodying my invention and thereafter they can readily insert and remove the device and thus provide for periodic control of the bowels, thus permitting patients who have heretofore become (or patients who might become) to a more or less degree a recluse, to take their place as normal members of society. The patient will become aware of any increased pressure because of the presence of secretions or gas in the intestine I4 and the patient may thus arrange fo removal of the device under proper conditions to drain the secretions and thereupon reinsert the device to thus provide for periodic control.

In producing a seal against secretions and gas in the intestines, the pressure of the inflatable member against the walls of the intestine, and thereby the annular portion of the intestines against the peritoneum adjacent the interior opening of the stoma, must be of such magnitude as to insure a tight seal and at the same time not develop an irritation. Mere pressure of the inflatable member against the interior walls of the intestine is not sufficient to insure posiively and definitely a seal against the accidental escape of secretions or gases. I have discovered that it requires something asa support o backing against which the inflatable member may press the intestine to secure the proper functioning of the pressure to bring about a tight seal. At the same time such pressure must involve a certain resiliency in order not to develop injury to the tissues involved. I have discovered that I can obtain the required degree of backing, as it were, and at the same time the required degree of resiliency by utilizing the body wall as the means against which the inflatable member through the medium of the intestines. The pad like member on the outer end of the tubular member functions as a means for holding the body wall so that it may serve as such backing up means.

of i

, erate to resiliently i In case'the patient is one who wears very tight clothing, or a corset, it is manifest that the t'ubular' membenmay be, pressed inwardly and I have provided aga'nst such pressinginwardly of the tubular member to operate to release the sealing function. I provide the inflatable member having such ellipsoid like shape or at least having such shape that when inflated it will ophold the annular portion of the intestines about the interior opening of the stoma against the peritoneal linin with a resiliency that permits moderately pressinginwardly of the pad like member and at the same time without breaking the seal between the inflatable member l6 and the intestine l4 created by pressure 'against'the peritoneal lining 13. In this connection the importance of the length ofthe tubular member isclear. Thelength of the tubular {membenaccordingly is adjusted tothe thickness off the'body wall of the patient. Ordinarily, the device will move with the body wall and there will be no relative movement between the tubular member I! and th body wall I ll-4 3. However, if there should be any such relative movement, the resiliency of the inflatable member will compensate and prevent the breaking of the seal as set forth.

The use of devices embodying my invention will mechanically serve also to prevent the prolapse of the colon which sometimes occurs in colostomies and it will also act in the same maner to prevent prolapse of the small bowel in cases of ileostomies.

Obviously, changes may be made in some of the forms, dimensions and arrangements of the parts of my invention without departing from the principle thereof, the above setting forth only preferred forms of embodiment.

I claim:

1. A device for periodically closing and opening the stoma of a patient who has been subjected to a colostomy, comprising a padmember having an inner annular contacting surface por carrying at one end portion thereof the said pad member; and an inflatable and deflatable mem ber secured to the other end portion of the tubular member, and positioned in spaced relatgi i to said pad member when inflated a distance substantially less than the normal thickness of the tissue between the epithelium layer and the peritoneal lining of a patient, whereby said inflatable and deflatable member may be inserted when deflated, and adapted, upon inflation, to move a portion of stantially parallel to the body wall, thereby to compress the said portion of the intestine and the tissue of the patient betweenthe epithelium layer and the peritoneal lining and thereby effectively block fecal discharge of liquids, solids and gases from the intestine leading to the stoma.

2. The method of controlling the periodic closing and opening of the stoma of a patient who has been subjected to a colostomy, comprising enlarging the intestine adjacent the body wall and moving the adjacent intestine portion substantially parallel to the body wall of the patient; blocking the central portion of the said stoma; and. in fecal-liquid, solid-and-gas tight I the intestine of a patient subm'anner, blocking the edgeportions of the stoma by resiliently urging the said adjacent intestine wall portion against the body Wall of the patient, thereby efiectively blocking the fecal discharge of liquids, solids and gases from the intestine leading to the stoma.

3. A device for periodically closing and opening the stoma of a patient who has been subjected to a colostomy, comprising a pad member having an inner annular contacting surface portion, said pad member being positionable external of a patient and with said surface portion in relatively close proximity to the stoma and in continuous supporting relation with the epithelium layer surrounding the stoma; a tubular member insertable in the stoma of a patient and carrying at the outer end portion thereof the said tubular member being outlet adjacent said inner end,

eral outlet and the outer tubular end portion; and an inflatable and defiatable member adapted inserted when deflated, and adapted, upon inflation, to move a, portion of the intestine of a patient substantially parallel to the body wall, thereby to compress the said portion of the intestine and the tissue OTIS F. LAMSON.

Images