Recurrent Stage 3 Sacral Pressure Injury in a Patient With Fistulizing Crohn's Disease: Clinical and Social Considerations

Abstract

Pressure injuries are challenging chronic wounds because healing depends on systemic and patient-specific factors in addition to local wound care. Patients with Crohn's disease may be particularly vulnerable to impaired healing because chronic inflammation, nutritional compromise, prior intestinal surgery, infection, and limited mobility can interfere with tissue repair. Sustaining improvement after hospital discharge may be further complicated by social barriers that limit continuity of wound care. We report the case of an adult man with advanced fistulizing Crohn’s disease who was admitted for evaluation of worsening drainage from a chronic vesicocutaneous fistula and was found to have a recurrent stage 3 sacral pressure injury. His medical history was significant for prior colectomy with colostomy creation, limited mobility, housing instability, and a sacral pressure injury that had previously healed before recurring. During hospitalization, the pressure injury was managed with regular wound assessment, dressing changes, frequent repositioning, oral nutritional supplementation, and multidisciplinary care, without evidence of worsening infection or a need for surgical intervention. This case illustrates the importance of addressing biological risks during inpatient wound management while also considering whether evidence-based care will remain feasible after discharge. However, post-discharge outcomes were unavailable; therefore, the proposed benefit of incorporating housing and resource constraints into discharge planning warrants further study.