Note: Descriptions are shown in the official language in which they were submitted.
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BACKGROUND OF THE INVENTION
The present invention relates generally to in-
testinal catheters and more particularly to a catheter for
insertion into the small intestine via the upper gastro-
intestinal tract.
The gastrointestinal tract comprises, in descending
order from the mouth or nose, the esophagus, the stomach,
the small intestine and the large intestine. The small
intestine or bowel comprises, in descending order, the duodenum,
connected to the stomach through an opening called the pylorus,
the jejunum, which connects with the duodenum at a location
identified by an adjacent ligament called the ligament of
Treitz, and the ileum which in turn connects with the large
bowel or colon. The duodenum includes two portions, a first
portion which is accessible to a surgeon when the abdomen
has been opened incident to the performance of surgery on
the small intestine, and a second portion, called the retro-
peritoneal portion, which is inaccessible to a surgeon when
the abdomen has been opened incident to surgery on the
small intestine.
Certain patients suffer from an obstruction in the
small intestine. This obstruction is caused by scar tissue
; on the outside of the small intestine which constricts
:;~ or squeezes the bowel causing the bowel upstream of the
obstruction to become massively dilated, i.e., swollen or
puffed up, while the bowel downstream of the obstruction
remains normal sized. The scar tissue which causes the
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obstruction usually occurs following abdominal surgery,
but it can occur from inflammation of the bowel. When the
obstruction occurs following abdominal surgery, it may occur
within any time from a few days to several years after the
surgery. Although some patients having such an obstruction
can be treated without surgery to alleviate the problem,
many such patients require surgery in order to alleviate
the problem. In such a case, the obstruction is removed by
a surgical procedure in which the abdomen is opened and the scar
tissue is cut away, thereby allowing the bowel on both
sides of the obstruction to eventually equalize.
Incident to such surgery, it is desirable to
aspirate or suck out the contents of the small bowel upstream of
the obstruction. Heretofore, this has been accomplished
by cutting an opening in the jejunum (a jejunostomy) up-
stream of the obstruction, inserting a catheter or intestinal
tube into the jejunum through the opening cut therein, and
aspirating the contents of the jejunum and ileum as the
catheter was moved downstream through the bowel towards the
obstruction. The contents of the bowel were aspirated up-
stream through the tube into the proximate or upstream end
of the tube, located outside the jejunum and connected to
an aspirator or source of suction.
It is not possible to push the tube through the
; length of the small intestine from the insertion hole to the
obstruction. Rather r the tube must be pulled through the
intestine by manual manipulation through the walls of the
intestine. Because the tube normally has a relatively small
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diameter, compared to the diameter of the jejunum, and be-
cause the tube becomes slippery once it is inserted into
the jejunum, the tube cannot be grasped through the walls of
the bowel, and grasping the tube through the walls of the
bowel is necessary if the tube is to be pulled through the
bowel.
In prior art intestinal tubes this problem was
solved by providing an inflatable balloon at the distal or
downstream end of the tube. Once the tube was inserted into
the jejunum, the balloon was inflated from the upstream
end of the tube, and this caused a bulge in the walls of the
jejunum which the doctor could grasp and then manipulate with
his fingers to work the balloon downstream along the length of
the small intestine until it reached the obstruction.
At the conclusion of the surgery, the tube was
worked further downstream through the small bowel and then,
with the tube in place throughout the entire length of the
small bowel, the tube acted as a guide for plicating the
small intestine into place within the abdomen. In other words,
the tube allowed the small bowel to be readily placed into
an arrangement of orderly folds or convolutions, within
the abdomen, without the occurrence of kinking in the small
bowel as it was arranged in the convoluted disposition.
The prevention of kinking is important. Otherwise, a new
obstruction could occur wherever a kink is located. The
inherent rigidity of the tube within the small bowel pre-
vented the bowel from kinking.
When the abdomen was closed following surgery,
the proximate or upstream end of the catheter tube was run
to the outside of the body, through an opening in the skin,
,
using a conventional surgical technique, and the tube was
allowed to remain in the jejunum for a number of days after
the surgery to assure that the small bowel remained in the
desired, unkinked disposition with regular folds or con-
volutions. During this postoperative period (e.g., 8-10
days), the contents of the small intestine could be drained
through the tube. Thereafter, the tube could be removed
through the opening in the skin using conventional techniques.
It has been found, however, that problems occurred
when the tube was inserted into the jejunum through an opening
cut into the jejunum for that purpose and when the proximate
end of the tube was brought to the outside of the body through
an opening cut in the skin of the patient for that purpose.
These problems included an increase in the wound infection
rate among patients, compared to the wound infection rate of
patients where this procedure was avoided. Additional
complications arising from this procedure included recurrent
obstruction at the site where the jejunum was cut, persistent
pain at the jejunostomy site, bursting open of the wound and
other complications. Many patients suffering from these
complications required re-operation.
SUMMARY OF THE INVENTION
The problems and complications arising from the
use of the prior art catheters described above are eliminated
by the use of a catheter, constructed in accordance with the
present invention, which is intended to be inserted into the
jejunum through the gastrointestinal tract upstream of the
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jejunum. More particularly, the downstream or distal end
of the catheter is inserted, in sequence, through the nose,
the esophagus, the stomach, the duodenum and then into the
jejunum.
Using this procedure, a problem could arise with
respect to that part of the catheter's insertion path which
runs through the retroperitoneal portion of the duodenum.
As noted above, this portion of the duodenum is not accessible
to a doctor when the abdomen has been opened to obtain access
to the constriction in the small intestine. Accordingly, an
inflatable balloon at the distal or downstream end of the
catheter becomes inaccessible to the surgeon once the balloon
enters the inaccessible portion of the duodenum. When the
inflatable balloon is inaccessible to the surgeon, it cannot
be manipulated by the surgeon to advance the catheter through
the small bowel. Complicated manipulative procedures or
other techniques would be required for advancement of
the catheter through the inaccessible portion of the duo-
denuml and the performance of these procedures or techniques
is undesirable.
In accordance with the present invention, ad-
vancement of a catheter through the inaccessible portion
of the duodenum is accomplished by providing the catheter
with a second inflatable balloon located upstream of the
first inflatable balloon a predetermined distance there-
from. The predetermined distance between the downstream
and upstream balloons is such as to place the upstream balloon
at an accessible location in the gastrointestinal tract,
upstream of the retroperitoneal or inaccessible portion of
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the duodenum, when the downstream balloon is inaccessible in
the retroperitoneal portion, and to place the downstream
balloon at an accessible portion of the gastrointestinal
tract, downstream of the retroperitoneal portion of the
duodenum, when the upstream balloon is inaccessible in the
retroperitoneal portion. Accordingly, when the downstream
balloon is inaccessible, the upstream balloon may be
manipulated by the doctor to advance the catheter, and, when
the upstream balloon is inaccessible, the downstream balloon
may be manipulated to advance the catheter.
As the catheter is advanced through the jejunum,
it may perform the usual aspirating function heretofore per-
formed by the prior art catheter. After the obstruction
has been alleviated, the catheter of the present invention
may be advanced to the distal or downstream end of the small
intestine and used for the internal plication of the small
intestine. ~he length of the catheter is such that, when
the downstream end of the catheter has been advanced to the
desired position in the small intestine, the remainder of
the catheter, upstream of its downstream end, extends back
through the gastrointestinal tract and out through the nose -
of the patient where it terminates at an upstream catheter
end which can be connected to a suction source.
After the surgery has been completed and the abdomen
closed, the proximate or upstream end of the catheter is
allowed to remain in a disposition extending out from the
~ nose of the patient, and, at the conclusion of the post-
-~ 30 operative period during which the catheter is allowed to remain
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in place, the catheter may be removed merely by pulling it out
through the nose.
An intestinal tube in accordance with the present
invention may be quickly and easily inserted into the jejunum
by the nasal-gastric route. Adequate aspiration of the small
bowel during the surgery is accomplished and plication of
the small bowel after surgery is readily achieved. In
addition, the problems and complications arising from cutting
an opening in the jejunum for insertion of the catheter are
eliminated.
Other features and advantages are inherent in the
structure claimed and disclosed or will become apparent to `
those skilled in the art from the following detailed description
in conjunction with the accompanying diagrammatic drawing.
BRIEF DESCRIPTION OF THE DRAWING
Fig. 1 is a perspective of an embodiment of a
catheter constructed in accordance with the present invention;
Fig. 2 is a perspective illustrating the manner
in which the catheter is advanced through the duodenum into
the jejunum;
Fig. 3 is a longitudinal sectional view of an
embodiment of the catheter;
Fig. 4 is a transverse sectional view taken along
Line 4--4 of Fig. 3; and
Fig. 5 is a longitudinal sectional view of another
embodiment of a catheter constructed in accordance with the
present invention.
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DETAILED DESCRIPTION
Referring initially to Figs. 1, 3 and 4, illustrated
in these figures is a catheter for insertion into the jejunum
via the stomach and the duodenum. This catheter comprises a
flexible tube 10 having an upstream or proximate end 11
and a downstream or distal end 12 connected by a lumen or
passageway 13 (Fig. 3). Located at upstream end 11 is a
coupling 14 for connection to a source of suction. Extending
from coupling 14 is a tubular portion 15 terminating at an
opening 16 surrounded by a flange 17. To effect suction,
opening 16 should be closed either with a plug (not shown)
or with a fingertip which may be removed to interrupt suction,
whenever suction interruption is desired.
~ ocated adjacent the tube's downstream end at 12
are aspirating slits or openings 20 for aspirating the
contents of the small bowel through tube 10 in response to
a suction applied at upstream end 11.
Also located adjacent downstream end 12 of tube 10
is a first inflatable balloon 21 surrounding the tube and
~ 20 ~ocated, in the illustrated embodiment, immediately upstream
of aspirating slits 20. Reerring to Figs. 1 and 5, com-
municating with first inflatable balloon 21, via a channel
23 is the downstream end of a second lumen 22 having an
upstream end located adjacent suction coupling 14 and
communicating with the downstream end of a condult 24 having
an upstream end communicating with a coupling 25 for con-
nection to a gas source such as a hypodermic syringe 26.
Depressing the handle 27 of hypodermic syringe 26 pushes air
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conduit 24, lumen 22 and channel 23 into first inflatable
balloon 21 to inflate the balloon.
Surrounding tube 10 at a location spaced a pre-
determined distance (e.g., 10 inches or 25 cm.) from first
balloon 21 is a second inflatable balloon 31. That portion
of tube 10 located between first and second inflatable
balloons 21, 31 is indicated at 34. Both balloons 21 and 31
are approximately toroidal or donut shaped (Figs. 3 and 5).
Second inflatable balloon 31 may be connected by
a channel 33 to second lumen 22 (Fig. 3), or second balloon
31 may be connected by channel 3,~ to a third lumen 32 (Fig. 5).
As shown in Fig. 5, third lumen 32 has a downstream
end located adjacent second inflatable balloon 31 and com-
municating therewith via passage 33. Third lumen 32 has an
upstream end located adjacent upstream end 11 of tube 10,
and this upstream end of third lumen 32 communicates with
a conduit similar to conduit 24 illustrated in Fig. 1.
As shown in Figs. 3-5, second and third lumens 22, 32 have
relatively small cross-sections compared to the cross
section of first lumen 13.
In the embodiment of Fig. 3, wherein the second
balloon 31 is connected to second lumen 22, both balloons 21
and 31 are inflated simultaneously when the handle 27 of
hypodermic syringe 26 is depressed. In the embodiment of
Fig. 5, third lumen 32 is connected, by a conduit similar
to the conduit 24 shown in Fig. 1, to a separate hypodermic
syringe similar to the hypodermic needle 26 shown in Fig. 1,
and second balloon 31 would be inflated independently of
the inflation of first balloon 21.
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Referring to Fig. 2, the accessible portion of the
duodenum is indicated at 41, and the jejunum, downstream of
the ligament of Treitz, is indicated at 40. The inacces-
sible or retroperitoneal portion of the duodenum is located
between accessible portion 41 and jejunum 40 and is hidden
from view in Fig. 2 by other portions of the internal
anatomy.
The predetermined distance between the first and
second balloons is such (e.g., about lO inches or 25 cm.)
as to place second balloon 31 at an accessible location in
the gastrointestinal tract, upstream of the inaccessible,
retroperitoneal portion of the duodenum, when first balloon
21 is inaccessible in the retroperitoneal portion, and to
place first balloon 21 at an accessible portion of the gastro-
intestinal tract, downstream of the retroperitoneal portion,
when the second balloon is inaccessible in the retroperitoneal
portion. Fig. 2 shows first balloon 21 just entering an
accessible portion of the gastrointestinal tract, in jejunum
40, as second inflatable balloon 31 is about to enter the
inaccessible or retroperitoneal portion of the duodenum.
In Fig. 2, tube portion 34, located between ballaons 21
and 31, is in the inaccessible or retroperitoneal portion
of the duodenum. As can be readily deduced from Fig. 2,
when first balloon 21 was inaccessible, during the time
it was in the retroperitoneal portion of the duodenum,
second balloon 31 was accessible in the accessible portion 41
of the duodenum. Similarly, when second balloon 31 enters
the inaccessible retroperitoneal portion of the duodenum,
first balloon 21 is readily accessible in the jejunum 40.
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i32~5
When either of the two balloons, 21 or 31, is
located in an accessible portion of the small intestine, the
bulges created by the inflatable balloon may be used by the
doctor to advance the tube through the small bowel or intestine.
As the tube advances through the small bowel up to the
obstruction therein, the contents of the small bowel are
removed by aspiration through slits 20, upstream through
the tube and out the upstream tube end ll. At the con-
clusion of the surgery, tube lO is advanced to the distal end
of the small bowel where it serves as a guide for arranging
the small bowel in regular folds or convolutions within the
abdomen. Tube lO has a length sufficient to extend at least
from the distal end of the small bowel back through the
gastrointestinal tract comprising the small bowel, the stomach,
the esophagus and the nose. The upstream end portion of
tube 10 extends outwardly through the nose, with at least
conduit 24 and everything upstream of the downstream end of
conduit 24 being located outside of the nose. A typical
length for tube lO would be about 350 cm.(140 inches).
Using the catheter of the present invention, and
the procedure described above, it is unnecessary, for insertion
of the catheter, to cut an opening in the jejunum, nor is it
necessary to cut an opening in the skin of the patient
through which the upstream end of the tube, and the elements
associated therewith, may project to the outside of the
patient's body. Accordingly, the problems and complications
which result from suoh procedures are avoided.
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As an alternative procedure to inserting the tube
through the nose, the tube may initially be inserted through
a surgical opening in the stomach (a gastrostomy) and from
there guided into the small bowel. Insertion of the tube
through an opening in the stomach is safer than insertion
through an opening in the jejunum (jejunostomy).
Tube 10 is composed of a physiologically inert
plastic or latex material heretofore used for conventional
catheters inserted via jejunostomy. Balloons 21 and 31 are
composed of a physiologically inert material, such as latex,
heretofore used for the single balloon on conventional
jejunostomy-insertable catheters. Tube 10 has a diameter
sufficiently small to facilitate its insertion via the nasal-
gastric route (e.g., about 5 mm. outer diameter or 16 mm.
circumference).
The foregoing detailed description has been given
for clearness of understanding only, and no unnecessary
limitations should be understood therefrom, as modificati~ns
will be obvious to those ski~led in the art.
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