Combination of Percutaneous Endoscopic Gastrostomy and Lumboperitoneal Shunt: A Case Report

The combination of percutaneous endoscopic gastrostomy (PEG) and cerebrospinal fluid (CSF) shunt surgery presents unique challenges in managing shunt-related infections. Although the association between PEG and ventriculoperitoneal (VP) shunt surgery is well documented, studies on the combination of PEG and lumboperitoneal (LP) shunt surgeries are limited. We report the case of a 70-year-old man who developed hydrocephalus after decompressive craniectomy for ischemic stroke. The patient required PEG for nutritional support and an LP shunt for CSF drainage. PEG was initially performed. After 16 days, an LP shunt was placed using the lateral approach to maximize the distance between the PEG site and abdominal incision. Subcutaneous CSF leakage was resolved without any shunt infection at the three-month follow-up. This case highlights the importance of strategically combining PEG and LP shunts to minimize infection risk. Maximizing the distance between the PEG site and abdominal incision for the LP shunt may help prevent shunt-related infections, warranting further clinical investigation.