![]() ![]() Cullen in 1918 following a ruptured ectopic pregnancy. The Cullen sign was first described by Canadian gynecologist Thomas S. However, descriptions of non-traumatic abdominal wall ecchymosis exist as far back as Hippocrates, Galen, and Leonardo da Vinci. There was a little edema, pitting on pressure, but no pain or tenderness." Since the publication of this article, the exam finding of ecchymosis of the flank in association with intra-abdominal bleeding has carried Dr. They were about the size of the palm of the hand, slightly raised above the surface, and of a dirty greenish color. Referring to a patient with severe pancreatitis, he wrote, "I now noticed two large discolored areas in the loins. For that reason, the Grey Turner sign is not always considered a sign of acute hemorrhage, but it can suggest a subacute process.īritish surgeon George Grey Turner published an article in 1920 that described finding subcutaneous discoloration of the flanks in patients with severe pancreatitis. This sign may not be seen initially on clinical exam as it can manifest after several days into the course of an illness. The discoloration observed in the flanks can be red, green, yellow, or purple, depending on the degree of red blood cell breakdown in the abdominal wall tissues, similar to bruising seen in any other tissue from traumatic causes. In addition, it can also be present in a few other conditions that result in intra-abdominal or retroperitoneal bleeding in someone on anticoagulation, a ruptured abdominal aortic aneurysm, rectus sheath hematoma, and ruptured ectopic pregnancy. These conditions carry similarly high mortality rates. This sign is classically associated with severe acute necrotizing pancreatitis, which can be associated with the Cullen sign (periumbilical ecchymosis) (see Image. Grey Turner and Cullen signs). Grey Turner sign is an uncommon subcutaneous manifestation of intra-abdominal hemorrhage that manifests as ecchymosis or discoloration of the flank.
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