US2587910A - Tall-tube for controlled intubation and drainage of the common bile duct - Google Patents

Description

March 4, 1952 SHULMAN 2,587,910

TTUBE FOR CONTROLLED INTUBATION AND DRAINAGE OF THE COMMON BILE DUCT Filed Dec. 23, 1949 STOMACH INVENTOR.

ALEXANDER G. SHULMAN Patented Mar. 4, 1952 UNITED STATES PATENT OFFICE T-TUBE FOR CONTROLLED INTUBATION AND DRAINAGE OF THE COMMON BILE DUCT Alexander G. Shulman, Los Angeles, Calif.

Application December 23, 1949, Serial No. 134,775

of the common bile duct.

It is one object of the herein described invention to provide an improved T-tube which will overcome the disadvantage of presently used types which upon becoming obstructed necessitate Waiting until clinical signs of cholangitis become evident and indicate such obstruction. In the tube of the present invention, such obstruction would be indicated immediately, and proper treatment may be taken to eliminate and correct the situation. Moreover, the usual need for post-operative X-ray photographs of the common bile duct is eliminated, since the common bile duct cannot become occluded when my improved tube is utilized, without previous evidence of such fact.

A further object of the invention is to provide such a tube which will permit total alimentation of the patient directly into the duodenum with saline, glucose solutions, amino acid mixtures, hydrolysed proteins or natural food mixtures, by in J'ecting the substances through the portion of the end of the tube which lies in the duodenum.

A further object of the invention is to provide an improved T-tube construction which is so arranged that the rate of bile outflow can be readily determined by collecting the bile outflow for a desired time, and which will permit the collected bile to subsequently be reinjected into the duodenum. Thus the tube of the present invention 'is advantageous in that it may be used for diagnostic purposes to determine the presence crabsence of liver disease.

Another object is to provide an improved T-tube construction which is so arranged that the bile flow may be readily controlled and gradually released. Slow decompression of the biliary system is thus made possible and prevents the theoretical danger of sudden decompression of the liver radicals to which the so-called liver deaths have 'the'flow channel. a Further objects and advantages of the invention will be brought out in the followin part of the specification, wherein detailed description is for the purpose of fully disclosing preferred and modified embodiments of the invention without placing limitations on its scope.

Referring to the drawings, which are for illustrative purposes only:

Fig. 1 is a view diagrammatically illustrating the use of a T-tube embodying the features of the present invention;

Fig. 2 is an enlarged view, partly in section, and certain parts bein cut away to more clearly show specific details of construction; and

Fig. 3 is a modified form of the invention.

Referring generally to Fig. 1, a T-tube as generally indicated at A, and constructed according to the present invention, is disclosed in a position of use. It will be noted that the T-tube comprises generally a cross-limb II) connected with a trunk I I connecting at its distal end with a, looped portion I2.

More specifically, the cross-limb I0 is positioned within the common bile duct I3 which conducts the bile fluid from the liver, as indicated at I4, and communicates through the sphincter of Oddi 15 with the lumen of the duodenum I6. The

trunk I I extends laterally through the abdominal wall H, the looped portion 12 being positioned externally for various purposes as will hereafter be more fully explained. One form of construction of a T-tube embodying the present invention is shown in Fig. 2. In that construction, the cross-limb I0 is in two parts consisting of a short single lumen tube I8 and a long single lumen tube #9, these two tubes being axially aligned and positioned in end-to-end respectively communicate with the lumina of the tubes I8 and I9 on each side of the partition 20. At the distal end of the tube 2I, the lumina respectively communicate with a tube connector of suitable material as indicated at 22. In the present instance, the connector comprises a pair of metal tubes 23-23 which are soldered. or otherwise secured together intermediate their ends as indicatedat 24 so as to form parallel connecting tube end portions 25-45 adapted to be inserted in the lamina of the tube 2|. The other ends of 3 the tubes 23-43 are deformed so as to diverge outwardly, and are provided with bulbous ends 26-26.

The looped portion I2 comprises a U-shaped section 21 of transparent glass or other suitable material, the section having bulbous connection ends 28-48. The ends 28-28 of the section 21 are respectively connected to the ends 26--26 of the tube. connector 22 by means of short tubes 29-29 of flexible material.

A modified and simplified construction is shown in Fig. 3. In this constructiQn, two. L shaped single lumen tubes 30-30 having right;angledv end portions 3 l-3I are secured together in backto-back relation by means of a bonding material 32, and with the legs 3l3l. extendingdn op posite directions but in axial, alignment with each.

other. The bonding material 32 extends from the end portions 3I3l to a point 33 whic h be described. Following surgical exploration of the common bile duct, the tube is positioned as shown in Fig. 1 so as to temporarily drain the cqmmehb e u il ali The sh t. t b 3 is inserted into the proximal. portion oi. the common. bi e du 1 he di o h h and he he ub l9. e ten s, m h is ltertion of the duct through the. sphincter of Odd into the lumen of; the duodenum. If it is desired that this end should not pass through the sphincter, the tube may be shortened by cutting it to} thefdesired length, The diameter of the tubes. I8. and le will be provided in suitable size tonu yv ithin he h mh il d t n which it is to be installed, During ordinary operation, flow of bile through the tube will be in the, directions indicatedby the arrows in Fig. 1. With the trunk l I extending through the abe dominal wall, and the looped portion, [2; positioned. outside, the bile flow may be. readily controlled by means, of. a suitable clamp placed on oneof the tube sections 29.

Whehu l zih h I-fi b -fo l m h a h. 2f the. patient directly into the duodenum, this' is accomplished by disconnecting the looped porionir mt e pw rm e d 25 f. the. onnect 22 and by connectingthereto suitable meansfor injecting the desiredsolution or mixturesthrough the'tube' [9 connecting with the duodenum In. diagnostic work, the upper connecting tube ot the tube connector 22 maybe connected, to suitable collecting vessel for receiying the bile outpi ts are l an by timin the eflecti the. rat hf fl w fr m th i r ay e. prope determined.

The. T-tubeof thepresent invention. is. partic. ularly advantageous since any obstruction to flow isindicatedat once without the-necessityof -haying to wait for clinical signs of cholangitisa In the event of an obstruction,this obstructionmay be relieved by irrigation and suction, Controlled irrigation through the tube- [9 with saline-,: anaesthetic solutions or ether for the dissolution of stones is possible without danger orpaindue to regurgitation or evaporation of irritating and toxic substances in the direction of the liver. Controlled undissipated suction on the tube is possible in the presence of overlooked small stones or debris so that such material. may.- be cap u ed a d prevent d om passihe 0.1. own into he Q Q nq ohs 0f he qmrhohbi d c The present T-tube is advantageous of use over the ordinary type of tube in that, where the opening at; the lower-end of tube; I 9, may be obstructed byalfold-of duodenal mucosa, uch fold may be pushed aside by injecting a small amount of saline into that arm of the double lumen portion of. the tube which leads directly to the obtructed. n

I' claim as, my. invention:

1. A device of the character described. comprising: asingle lumen first tube; partition means insaid tube separating it into a short upper limb and a relatively longer lower limb; a double lumen second tube extending laterally from said first tube and forming therewith a generally T- h ed. truc re. the. m na a one. and Q? the second. tub in r ect velx in. o municat hwith h hteit r o he. fi st, uba h. 0121 .0: site sides of said partition neans; metallic tabui r. chhhectors.commun cat ng w h the umihe. at h o h r n of he cohd ube; a re s e' h be; and f exibl ubularqqhhe tiohs-remhv hh' connecting h nd o h rahsnarehtthbe. with the metal onnec o s.

A. ev o the haracte escribe c.0 32- p i n s e e l m n. first tubenpartiti in s id t e a at n itihtos g io s 035 3169111 1 h qo ne ihathe end of h tren arehttuhh V h. hev m a hnectm' f 3. Aj device of the character described, com,- p ezh ihe e r b pa t ti n-m ans d, t be; ub e u chhd. ube. xten ing hte a la m said fir t ub and fa ming her with a g nera ly h ed'st uc re. he lumina'at, one end of the; second tube being re s eqti el in c mmu at on h he n eri r o th r t ub n, opp s e. de f a ert ti h m ans; id. bula o nector pmm a he with. th emma at. he o he e d f e second tub at ah herent be; nd. con c i ns e.- tween the end of the transparent tube andfthe rigid tubular connectors.

m htatioa a d hen-n0 fdr hee hmueh he 9mm .hfleducthomh isine; a ha r-o tubhs in quart whine; p r i i n. m a s ppes h direct be we n he a jacent 2.9 of; aid tuh srehdmeans.definin at rall e n he looped flow connection from the adjaeentgtube nd on on i e: .aicl1 n r it qhitq; t e adja e wheehd; on. the: other; ide Qt a d pert tim.

connection between the other set of ends of said 2 trunk fiow passages; and a transparent window for viewing material flowing through a trunk flow passage.

'7. A device of the character described for alimentation and control of drainage through the common bile duct, comprising: a pair of tubes in end-to-end relation; means opposing direct flow between the adjacently disposed ends of said tubes; means defining a plurality of lateral trunk flow passages respectively communicating at one set of their ends with the interior of said pair of tubes at the adjacently disposed ends; and a flow connection between the other set of ends of said trunk flow passages including a transparent section through which the flow therein is visible.

8. A device of the character described for alimentation and control of drainage through the common bile duct, comprising: a pair of tubes in end-to-end relation; means opposing direct flow between the adjacently disposed ends of said tubes; means defining a plurality of lateral trunk flow passages respectively communicating at one set of their ends with the interior of said pair of tubes at the adjacently disposed ends; and a disconnectable flow connection between the other set of ends of said trunk flow passages.

9. A device of the character described, comprising: elongate tubular means having its end portions deflected at right-angles, said means being looped between its ends; means securing A opposite side portions of the loop together with the deflected end portions axially aligned and extending in opposite directions to form with the secured portions of the loop a. generally T-shaped structure; and a, disconnectable transparent section in said loop.

10. A device of the character described, comprising: a tube adapted to be positioned in the common bile duct for conducting flow of bile from the liver to the duodenum, said tube having a partition inwardly spaced from one of its ends; tubular means defining a by-pass flow passage around said partition, said means including a looped portion adapted to be positioned exteriorly of the abdominal wall; and a transparent wall section in said looped portion through which the flow may be observed.

11. A device of the character described for alimentation and control of drainage through the common bile duct, comprising: means defining aligned tubular main passages in end-to-end relation: means opposing direct flow between adjacently disposed ends of said main passages; means defining a plurality of lateral trunk flow passages, each of said trunk passages communieating at one of its ends with the interior of one of the adjacently disposed ends of said main passages; and a flow connection between the other ends of said trunk flow passages.

ALEXANDER G. SHULMAN.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS.

Number Name Date 1,234,106 Hodgson July 1'7, 1917 FOREIGN PATENTS Number Country Date 191,092 Switzerland Aug. 16, 1937 OTHER REFERENCES Items G. O. 2372 and G. O. 2374 on page 391 of the Complete General Catalog of V. Mueller and 00., published in 1938. Address of V. Mueller and Co., Ogden Avenue at Van Buren Street. Chicago, Illinois.

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