Open Witzel feeding jejunostomy for enteral nutrition in a patient with gastric linitis plastica and Bombay blood group: a case report

Swathy Elangovan; R. Sivamarieswaran

doi:10.18203/2349-2902.isj20254349

Authors

Swathy Elangovan Department of General Surgery, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India
R. Sivamarieswaran Department of General Surgery, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20254349

Keywords:

Jejunostomy, Enteral nutrition, Palliative care, Stomach neoplasms, Signet ring cell carcinoma

Abstract

To present a rare case of advanced gastric linitis plastica with malignant ascites and the Bombay (hh) blood group, managed successfully with open Witzel feeding jejunostomy for palliative nutritional support and facilitation of systemic chemotherapy. A 42-year-old female presented with progressive abdominal distension, early satiety, nausea, and weight loss. Clinical evaluation revealed severe malnutrition, ascites, and gastric outlet obstruction. Endoscopy and biopsy confirmed signet ring cell carcinoma (diffuse type). Due to the presence of gross ascites and the rare Bombay blood group, open Witzel feeding jejunostomy was selected over laparoscopic techniques for safe enteral access. The procedure was performed under intravenous sedation via an upper midline laparotomy. The postoperative course was uneventful. Enteral feeding through the jejunostomy tube was initiated on postoperative day one and supplemented with oral feeding by day five. The patient showed improved nutritional tolerance and was started on Capecitabine chemotherapy under palliative intent. No early postoperative or transfusion-related complications were reported. Open Witzel feeding jejunostomy is an effective and safe approach for enteral nutritional support in advanced gastric cancer cases with contraindications to laparoscopy. In patients with rare blood groups such as Bombay (hh), open techniques provide better intraoperative control and transfusion preparedness, supporting individualized surgical decision-making in complex oncologic care.

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