Rectal Sleeve for Fecal Diversion in the Management of a Sacrococcygeal Stage IV Pressure Ulcer in a Dementia Patient: A Non-surgical Alternative to Colostomy

TL;DR

A rectal sleeve was successfully used to manage a severe pressure ulcer in a dementia patient, avoiding surgery.

Contribution

This case introduces a non-surgical fecal diversion method using a rectal sleeve for advanced pressure ulcers.

Findings

A rectal sleeve enabled effective wound healing in a stage IV pressure ulcer without surgery.

The patient showed marked improvement with combined wound care and nutritional support.

The technique avoided surgical risks and could be a viable alternative to colostomy.

Abstract

Pressure ulcers are a serious and frequent complication in patients with moderate-to-severe limitations in their mobility. Advanced sacral ulcers are particularly susceptible to fecal contamination, which has a negative impact on wound healing. Surgical colostomy is often considered for fecal diversion but carries significant risks. This case presents an innovative, minimally invasive alternative using a rectal sleeve. We report the case of a 67-year-old Caucasian male with Alzheimer’s dementia, who presented with a chronic, stage IV sacrococcygeal pressure ulcer measuring 20 × 15 cm. Surgical debridement was performed, followed by the application of a rectal sleeve for fecal diversion. Combined with nutritional optimization and daily wound care, the ulcer showed marked improvement without the need for any surgical intervention. This case highlights the successful use of a rectal sleeve as a non-surgical alternative to colostomy in managing advanced sacral pressure ulcers. The technique allowed effective wound healing and avoided the risks associated with surgical fecal diversion. Further research may validate its broader clinical use.

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