Abstract:
A receptacle for collecting intestinal contents is designed for surgical implant in the abdominal cavity of a patient who, post-operatively lacks the whole or part of the small intestine, large intestiine or the rectum. The receptacle comprises a connection device for connection to the intestine of the patient and an emptying device which is secured in the abdominal wall of the patient. The emptying device realises a closable passage through the abdominal wall. Further, the receptacle includes an inner container ( 4 ) or ampoule and an outer casing ( 3 ). The inner container or ampoule consists of a gas- and liquid-tight material which is flexible and somewhat elastic. The outer casing ( 3 ) consists of a flexible but substantially unstretchable material. The ampoule ( 4 ) and the outer casing ( 3 ) are united ot one antoher at the connection device and the emptying device.

Description:
TECHNICAL FIELD  
         [0001]    The present invention relates to a receptacle for the collection of excrement and designed for implant in the abdominal cavity of a patient who, post-operatively, lacks the whole or part of the small intestine, large intestine or the rectum, the receptacle comprising a connection device for connection to the intestine of the patient and an emptying device which realises a closable passage through the abdominal wall of the patient and is fixed therein.  
         BACKGROUND ART  
         [0002]    Many intestinal diseases entail an operative removal of all or parts of the small intestine and/or the large intestine and also the rectum, often as a result of cancer. In order thereafter to be able to make possible emptying of the intestine, a colostomy is applied today. This entails that the remaining end of the intestine after this operation is moved by operation to an external skin surface, whereafter the contents of the intestine are collected in a colostomy pouch. This involves major problems for many patients, such as the constant worry about leakage and odour which in many cases causes discomfort in stressful public meetings, presentations etc., in working life. Social life will also be inhibited, such as at dinners, baths, saunas, not to mention sexual performance. The private feeling of never being clean, of constantly carrying a small bag packed with colostomy pouches etc., as well as changes of clothing, are major difficulties. In addition, there are medical drawbacks, such as hernias, problems involving omentum majus et minor, skin irritations, eczema, necrosis etc.  
         PROBLEM STRUCTURE  
         [0003]    The present invention has for its object to design the receptacle intimated by way of introduction such that the drawbacks inherent in prior art technology and methods are obviated.  
         SOLUTION  
         [0004]    The object forming the basis of the present invention will be attained if the receptacle intimate by way of introduction is given the characterising features as set forth in appended claim 1. 
       
    
    
     BRIEF DESCRIPTION OF THE ACCOMPANYING DRAWINGS  
       [0005]    The present invention will now be described in greater detail hereinbelow with reference to the accompanying Drawings. In the accompanying Drawings:  
         [0006]    [0006]FIG. 1 is a view straight from the side of the subject matter of the present invention implanted in a patient:  
         [0007]    [0007]FIG. 2 is a view corresponding to that of FIG. 1, but seen straight from the front;  
         [0008]    [0008]FIG. 3 shows the receptacle according to the present invention seen separately;  
         [0009]    [0009]FIG. 4 shows those devices by means of which the subject matter of the present invention is secured in the patient&#39;s abdominal cavity;  
         [0010]    [0010]FIG. 5 shows an emptying device included in the subject matter of the present invention;  
         [0011]    [0011]FIG. 6 is a further view of the emptying device according to FIG. 5;  
         [0012]    [0012]FIG. 7 shows the emptying device according to FIGS. 5 and 6 and an evacuation tube with a filter included therein;  
         [0013]    [0013]FIG. 8 shows the emptying device in the permanently operated state in a first embodiment;  
         [0014]    [0014]FIG. 9 is a view corresponding to that of FIG. 8 of an alternative embodiment;  
         [0015]    [0015]FIG. 10 shows a connection device included in the subject matter of the present invention;  
         [0016]    [0016]FIG. 11 shows a communication tube to the interior of the abdominal cavity included in the emptying device according to FIG. 5;  
         [0017]    [0017]FIG. 12 shows a catheter designed for emptying the receptacle;  
         [0018]    [0018]FIG. 13 is a view straight from the front showing emptying of the subject matter of the present invention; and  
         [0019]    [0019]FIG. 14 shows the catheter according to FIGS. 12 and 13 with its package. 
     
    
     DESCRIPTION OF PREFERRED EMBODIMENT  
       [0020]    It will be apparent from FIG. 1 that the receptacle according to the present invention is operated into the lower part of the patient&#39;s abdominal cavity inside the abdominal wall  14 . The receptacle consists of two main components, an inner container or ampoule  4  of a gas- and liquid-tight material which is flexible or possibly somewhat elastic, and an outer envelope or casing  3  which is produced from a flexible but substantially unstretchable material. As an example of suitable materials for the ampoule  4 , mention might be made of a silicon material, and as regards the outer casing, titanium or a titanium alloy. The outer casing  3  is in the form of a net which encloses the ampoule  4 . At the rear/upper end of the receptacle, there is disposed a connection device which int. al. includes an interjacent member  9  which places the interior of the receptacle in communication with the intestine  10 .  
         [0021]    In the front/lower end of the receptacle, there is provided an emptying device which int al. includes an outer fixing plate  17 , an inner fixing plate  23  and a lid  15 . A more detailed description of the emptying device and the connection device will be given below.  
         [0022]    As is apparent from FIGS. 1 and 2 together, the receptacle is elongate with approximately twice as great a length as diameter or transverse dimension. The configuration is approximately an ellipsoid, but may also deviate from this basic configuration. The receptacle has a longitudinal axis which, in the sagittal plane, inclines approximately 35-45° to the horizontal. As will be described in greater detail below, the receptacle is fixed, e.g. in omentum majus et minor or alternatively in the muscular structure of the rear abdominal wall. However, this fixing is not absolute, but must permit a certain possibility of movement of the order of magnitude of 3-4° in all directions. Further, the front/lower end of the ampoule is fixed in the abdominal wall via the fixing plates  17  and  23 .  
         [0023]    In FIG. 2, reference numeral  1  relates to the front opening of the receptacle via which the contents of the intestine may pass from the receptacle to the ambient surroundings outside the abdominal wall  14 . Reference numeral  2  relates to a front connection to the receptacle, by means of which connection the receptacle is connected to the emptying device.  
         [0024]    In FIG. 3, the receptacle is shown separately and approximately in the orientation it assumes after being operated into the abdominal cavity of the patient (Cf. FIG. 2). As was mentioned above, the receptacle comprises an inner container  4  or an ampoule which is produced from a lightly flexible, ideally somewhat elastic silicon material so that thereby the configuration of the inner receptacle may change in response to its level of filling. The outer casing  3  consists of a net of titanium threads which are so thin that they are relatively lightly flexible but naturally only stretchable to an extremely limited extent. This implies that the outer casing  3  lies fixed in an upper limit to which the ampoule  4  may be filled regardless of the inner pressure in it. The inner receptacle  4  and the outer casing  3  are free from one another and are movable in relation to one another apart from in the regions of the connection device and the emptying device. In FIG. 3, this situation is illustrated in that the receptacle has, in its upper/rear end, a rear connection  6  which serves for joining together the inner container or ampoule  4  and the outer casing  3 . The rear connection  6  has a rear opening  5  via which the contents of the intestine pass into the receptacle. Correspondingly, the receptacle has, in its front/lower end, a front connection  2  with a front opening  1 . The front connection  2  also serves for interconnection with or communication between the inner container or ampoule  4  and the outer casing  3 . The lower or front connection  2  has a through-going opening via which the contents of the intestine pass from the receptacle via the emptying device and out to the ambient surroundings.  
         [0025]    [0025]FIG. 4 illustrates how the receptacle, apart from via the emptying device, is interiorly secured in the abdominal cavity of the patient. As will be apparent from both FIG. 3 and  4 , the outer casing  3  has a number of coupling rings  7  which suitably enclose two mutually intersecting titanium threads in the outer casing. The coupling rings serve for securing anchorage threads or anchorage loops  8  which, as was mentioned above, have anchorages  11  interiorly in the abdominal cavity of the patient. Reference numeral  12  relates to diaphragms and reference numeral  13  to an abdominal wall system which realises an openable and closable passage through the abdominal wall  14  and which encloses the greater part of the emptying device.  
         [0026]    It will be apparent from FIGS. 5 and 6 together that the abdominal wall system/the emptying device  13  includes a tubular, exteriorly threaded  25  part of a faecal emptying channel  24 . The tubular part is connected via a threaded connection to the front connection  2  of the receptacle and extends through the inner fixing plate  23  and is also in threaded mesh therewith. On screwing of the inner fixing plate  23  in towards the connection  2 , sealing will be realised by the intermediary of a sealing membrane  26  which is placed between the connection and the fixing plate.  
         [0027]    The outer fixing plate  17  has a central, through-going aperture through which a fixing nut  20  may be passed into engagement with an outer end section of the emptying channel  24  and its exteriorly threaded section  25 . The fixing nut  20  has a conical outer end member which cooperates with a corresponding conical hole in the outer fixing plate  17 . For preventing mutual rotation between the fixing nut  20  and the outer fixing plate  17 , this has two holes  19  via which rotation-impeding means may be inserted into cooperation with the fixing nut  20 .  
         [0028]    In its outer, outwardly facing end, the fixing nut  20  has engagement means for fixedly securing an emptying lid  15  which has a locking device  16 .  
         [0029]    Through the two fixing plates  17  and  23 , there extend, on the one hand, an evacuation tube  21  and, on the other hand, a communication tube  22 . The evacuation tube discharges with its one, outer end on the outside of the outer fixing plate  17  and with its opposing, inner end, interiorly in the ampoule  4  at reference numeral  28 . The communication tube  22  discharges with its outer end in an opening on the outside of the outer fixing plate  17  and with its opposing, inner end on the inside of the inner fixing plate  23 , i.e. directly in the abdominal cavity of the patient. The discharge openings for the evacuation tube  21  and the communication tube  22  on the outside of the outer fixing plate  17  are shown in FIG. 9 at reference numerals  40  and  41 , respectively. Further details will be presented below as regards the evacuation tube  21  and the communication tube  22 .  
         [0030]    [0030]FIG. 10 shows the connection device with the rear connection  6  of the inner container or ampoule  4  and a coupling  42  fixedly secured therein and also having the through-going rear opening  5 . The coupling  42  is intended for interconnection with a corresponding coupling or anchorage ring  43  which is located at the front/lower end of the interjacent member  9  which, at its upper, rear end, is secured via sutures  44  to the front, lower end of the intestine  10 . The interjacent member  9  may suitably be produced from a fibrous or porous material such as Dacron® or Gore Tex®. The intestine  10  extends into the interjacent member  9  which may have a length of the order of magnitude of 5-8 cm. In order to facilitate the growth of intestinal epithelium in the interjacent member  9  and thereby improve the connection, the inside of the interjacent member is prepared with a thin matrix which is to constitute stroma for the growth of intestinal epithelium. This matrix consists of a stratum of collagen and/or fibrinonectrine. Growth factors may also be prepared in the matrix which stimulate the growth of intestinal epithelium. Thus, the intestinal epithelium will grow into the interjacent member  9  and form a safe and reliable connection with it.  
         [0031]    The employment of the above-mentioned interjacent member  9  implies two advantages. First, it absorbs the intestinal peristalsis, i.e. the movement executed by the intestine for transporting the intestinal contents in a direction towards the receptacle. Secondly, the employment of the interjacent member  9  makes it possible that only one single operative intervention need be carried out since the intestine  10  is sutured direct to the interjacent member  9 . This implies a direct connection which may be used immediately.  
         [0032]    [0032]FIG. 9 shows the emptying device in the assembled and mounted state and it will be apparent that the evacuation tube  21  has a discharge opening  40  in the outer fixing plate  17 , while the communication tube  22  has a corresponding opening  41 . At the inner end of the evacuation tube, there is disposed a sensor which is located in the ampoule  4  and is in direct contact with its contents. The sensor is employed for registering changes of the pressure interiorly in the ampoule and emits a signal when the pressure reaches a certain critical level, which implies either that the discharge of gases from the ampoule must be put into effect, or that the ampoule must be emptied. In such a state, the sensor  28  emits a warning signal to the patient.  
         [0033]    In the embodiment according to FIG. 8, a sensor  37  is placed higher up and further back in the ampoule  4  as well as interiorly in it. This sensor  37  is connected, via a conductor  38 , to the outside of the outer fixing plate  17  where a battery ampoule  39  is placed for current supply, on the one hand, to the sensor  37  and, on the other hand, to the signal device which warns the patient when, for example, the receptacle ampoule is filled to approximately 90%.  
         [0034]    Both FIGS. 8 and 9 show, on the outside of the outer fixing plate  17 , aperture anchorages  36  for the emptying catheter which is employed on emptying of the ampoule. In addition, FIG. 8 shows a valve  35  which is intended for closing the through-going emptying channel  24  when no emptying is to take place. The valve  35  may be constructed in accordance with the same principles as a so-called iris shutter or diaphragm and is operated by the emptying catheter via the anchorages  36 .  
         [0035]    On release of gases from the interior of the ampoule  4  without simultaneous emptying of the intestinal contents therein, the evacuation tube  21  is employed. According to FIG. 7, the evacuation tube  21  is interiorly provided with a filter which is accessible on the outside of the outer fixing plate  17  beside the emptying valve  35 . Replacement of filter may also be put into effect via the outer opening  40  (FIG. 9) of the tube  21 . Via the same opening, replacement of the sensor which is placed at the inner end of the tube  21  may also be put into effect.  
         [0036]    In an alternative embodiment, the filter is placed in an insert tube  29  which is insertible in and removable from the evacuation tube  21 . The insert tube  29  has an inner heel  31  which prevents excessively long insertion of the insert tube  29 . Interiorly, the insert tube is filled with a filter  32  and has recesses  33  for a gripping tool  30  by means of which the insert tube may be inserted into and removed from the evacuation tube  21 .  
         [0037]    The communication tube  22  has, as was mentioned above (see FIG. 9), a discharge opening  41  in the outer fixing plate  17 . The opposing end of the tube discharges interiorly in the abdominal cavity of the patient. It will be apparent from FIG. 11 that the communication tube  22  has an outer surface  45  and that this is provided with an insert tube  46  which has an outer surface  47  which connects to the inner surface in the communication tube. The insert tube  46  is insertible in and removable from the communication tube and, to this end, has gripping anchorages  50  in which forceps  56  may engage.  
         [0038]    The insert tube  46  has a central, through-going injection passage  48  which, in the outer end, connects to a conical centring funnel  49  which makes it easier to centre, for example, an injection syringe for passage into the injection passage  48 .  
         [0039]    In the outer end, the insert tube  46  is covered by means of a membrane  54  which has a centring zone  55  in its centre. The outer end of the insert tube is further provided with anchorage recesses  51  for securing a lid  52  which, on its inner side, has gripping claws for fitting and locking in the above-mentioned recesses  51 .  
         [0040]    If larger instruments are to be passed through the communication tube  22  to the interior of the abdominal cavity, for example, for minor operative interventions, fibre optics or the like, the insert tube  46  is removed in its entirety.  
         [0041]    [0041]FIG. 12 shows an emptying catheter  57  which, in principle, consists of a readily flexible plastic hose of slight wall thickness. The upper end of the catheter is secured in an anchorage  58  which has a centring plate  59  with gripping claws  60  for cooperation with the opening anchorages  36  on the outer fixing plate  17 . By cooperation of the gripping claws  60  and the above-mentioned opening anchorages  36 , it is possible, on the one hand, to connect the catheter to the outer fixing plate and, on the other hand, to open and close the valve  35  which is disposed at the fixing plate.  
         [0042]    [0042]FIG. 13 shows how the emptying catheter has been secured at its anchorage  58  on the outer fixing plate  17  on the skin of the patient&#39;s abdomen. The Figure also illustrates how the catheter extends down into a toilet bowl.  
         [0043]    It will be apparent from FIG. 14 that the catheter  57  and a skin-coloured plaster  61  may suitably be packed in a single-use disposable package  62 . On use, this package is opened and the catheter is removed and used, whereafter the plaster is placed over the fixing plate. Thereafter, the used catheter may once again be placed in the package  61  and the whole unit be deposited in a suitable refuse vessel  63 .  
         [0044]    In the foregoing, consideration has been given to the design of the two fixing plates  17  and  23 . Suitably, these plates, but also the emptying channel  25 , the evacuation tube  21  and the communication tube  22 , are- produced from titanium. In order to prevent necrosis in the abdominal wall, the two fixing plates are perforated and, as was mentioned above, have an adjustment capability towards and away from one another so that the abutment pressure against the abdominal wall  14  may thereby be modified.  
         [0045]    On surgical implant of the emptying device in place, the outer fixing plate  17  is sutured in position on the skin of the abdominal wall. Further, the inner fixing plate  23  is sutured in place against the inner surface of the abdominal wall  14 .