Kennedy Terminal Ulcer – the Beginning of the End (a Case Report)

Abstract

Cilj: prikazati rijedak slučaj promjene kože nazvan Kennedyjev ulkus (KTU), koji se javlja u bolesnika u terminalnom stadiju života te naglasiti važnost ovog entiteta u kliničkoj praksi. Prikaz slučaja: Sedamdesetogodišnjoj bolesnici, koja je bila na palijativnom liječenju u stacionaru, utvrđena je rana na sakrumu za koju se zbog njezinih posebnih karakteristika, izgleda, lokalizacije te brzine progresije posumnjalo da se radi o posebnom entitetu i vrsti rane, odnosno o Kennedyjevu ulkusu. Kennedyjev terminalni ulkus neizbježno je oštećenje kože koje se javlja kao dio procesa umiranja. Oskudna literatura sugerira da se Kennedyjevi terminalni ulkusi javljaju iznenada, obično su kruškolikog oblika, locirani u sakralno/kokcigealnoj regiji, crvenožute ili crne boje, izgledom slični abraziji, a javljaju se nedugo prije smrti. Unatoč sveobuhvatnoj njezi i svakodnevnoj brizi i tretmanu, promjena na koži vrlo je brzo progredirala u ulkus IV. stupnja, a bolesnica je nakon sedam dana preminula. Zaključak: U svakodnevnoj praksi o Kennedyjevu terminalnom ulkusu vrlo se malo zna i velik se broj takvih promjena ne otkriva te ih se pogrešno evidentira kao dekubitalne rane. Potrebna su daljnja istraživanja o fenomenu oštećenja kože kod svih palijativnih bolesnika te dodatna edukacija medicinskih djelatnika kako bi se što više pridonijelo ublažavanju boli i dostojanstvenom životu umiruće osobe, ali i ostalih sudionika uključenih u brigu o terminalnom bolesniku.Aim: to present Kennedy terminal ulcer (KTU), a rare case of skin injury that occurs in patients in their terminal stage of life, and to emphasize the importance of this entity in clinical practice. Case report: A 70-year-old woman who was undergoing palliative treatment in the hospital, was diagnosed with a wound on the sacrum. Due to its special characteristics, such as appearance, location, and speed of progression, the wound was suspected not to be an ordinary pressure ulcer but a special entity, the so-called Kennedy terminal ulcer. Kennedy terminal ulcer is an inevitable skin breakdown or deterioration that occurs as part of the dying process. Kennedy terminal ulcers appear suddenly, are usually pear-shaped, located in the sacral/coccygeal region, red – yellow, or black in colour, abrasion-like in appearance, and occur shortly before death. Despite comprehensive care and daily care and treatment, the change on the skin progressed very quickly into a grade IV ulcer, and the patient died after seven days. Conclusion: In everyday practice, very little is known about Kennedy’s terminal ulcer and a many of such changes are not detected and are incorrectly recorded as decubitus wounds. Further research is needed on the phenomenon of skin damage in all palliative patients, as well as for other members involved in the care of dying patient