Tanaka Tatsuya, Kumono Takahiro, Naito Tomoyuki, Yamane Fumitaka, Matsuno Akira
Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, JPN.
Department of Neurosurgery, International University of Health and Welfare Atami Hospital, Atami, JPN.
Cureus. 2024 Sep 30;16(9):e70527. doi: 10.7759/cureus.70527. eCollection 2024 Sep.
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.
经皮内镜下胃造口术（PEG）与脑脊液（CSF）分流手术相结合，在处理分流相关感染方面存在独特挑战。尽管PEG与脑室腹腔（VP）分流手术之间的关联已有充分记录，但关于PEG与腰腹（LP）分流手术联合应用的研究却很有限。我们报告一例70岁男性患者，其因缺血性中风行减压颅骨切除术后发生脑积水。该患者需要PEG进行营养支持，并需要LP分流进行脑脊液引流。最初进行了PEG。16天后，采用侧路放置LP分流管，以使PEG部位与腹部切口之间的距离最大化。在三个月的随访中，皮下脑脊液漏得到解决，且未发生任何分流感染。该病例凸显了策略性地联合PEG和LP分流以将感染风险降至最低的重要性。使LP分流的PEG部位与腹部切口之间的距离最大化可能有助于预防分流相关感染，值得进一步的临床研究。
