Hunger Sensations in a Patient After Total Gastrectomy.

The contraction of the empty stomach is regarded as an essential element in the sensation of hunger in man and animals on the basis of numerous experimental studies, although the possibility of other factors contributing to hunger has been considered. Carlson, 1 and Ivy and Vloedman 2 expressed interest in the question of hunger following removal of the stomach but were unable to find in the literature any reports based upon complete gastric excision. An opportunity to investigate the question of hunger sensation in man following removal of the stomach was afforded by a patient upon whom total gastrectomy had been performed (by O.H.W.) for carcinoma of the stomach. In this operation the proximal end of the duodenum was closed and an anastomosis made between the esophagus and jejunum. As the removed specimen included the entire stomach, more than 2 cm. of esophagus and a portion of the duodenum, no doubt remains regarding the question of complete gastric excision. Ten months following the procedure the patient returned for observation at our request, stating that he was in the best of health. X-ray examination demonstrated a good functioning stoma. There was no dilatation of the jejunum immediately distal to the anastomosis. Both vagi nerves were divided in the operative procedure but the patient's bowels moved regularly as previous to the operation. There was no evidence of anemia. He became hungry frequently and we felt that it would be of interest to investigate the hunger sensations in a gastrectomized patient. Unfortunately he could not recall ever having had either before or after operation, any sensation he would describe as a hunger pang. To him the sensation was one of emptiness in the stomach followed by a feeling of general weakness.