Year 2024 / Volume 116 / Number 5
Letter
Uncommon etiology of Cullen sign and Grey Turner sign

280

DOI: 10.17235/reed.2023.9655/2023

Marta Álvarez-García, Lola Otegui Martínez-Peñuela, Rocío Calvo Hernández, Juan Carlos Porres Cubero,

Abstract
Cullen´s sign and Grey Turner sign are, respectively, the cutaneous ecchymoses located in periumbilical region and tissues flanks along the lower portion of the abdomen. Both have been observed in <1% of individuals with acute pancreatitis, suggesting poor prognosis in terms of gravity and mortality. However, these signs are not exclusive for acute pancreatitis, as they can appear in other identities such as: ruptured ectopic pregnancy, aortic aneurysm, rectus abdominis muscle hematoma, perforated duodenal ulcer, common bile duct rupture and biliary peritonitis, idiopathic perirenal hemorrhage, infectious mononucleosis with splenic rupture, metastatic esophageal and thyroid cancer, non-Hodgkin lymphoma, amoebic liver abscess, portal hypertension, and liver tumor disease. Based on the review of the literature, it is patent that Cullen´s sign and Grey Turner sign are neither sensitive nor specific for acute pancreatitis, therefore it may be best to relate these findings in the physical examination to conditions associated with abdominal pathology and retroperitoneal hemorrhage. We report the case of a 60-year-old Spanish female, with previous history of squamous small cell neuroendocrine lung carcinoma with hepatic extension in follow-up by palliative care services. Due to disease progression after two palliative chemotherapy sessions, the patient came to the emergency room with jaundice and abdominal pain in superior regions. On physical examination, notable findings included ecchymoses in the right flank and periumbilical region. Laboratory findings showed elevated bilirubin and transaminase levels, as well as a small increase in the serum amylase and lipase levels. Cholangioresonance was performed to discard acute biliary pancreatitis. The imaging revealed no enlargement of the pancreas, dilatation of the common bile duct without visible stone, and a liver full of new cancerous liver implants. These findings were consistent with diffuse distribution metastases lesions, concluding the progression of liver disease.
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References
1. Wright WF. Cullen Sign and Grey Turner Sign Revisited. J Am Osteopath Assoc. 1 de junio de 2016;116(6):398-401.
2. Cienfuegos JA, Valentí V, Rotellar F. Acute pancreatitis: an opportunity for gastroenterology hospitalists? Rev Esp Enfermedades Dig. 2022; 114:73-75.
3. Kashiwagi R, Shimamura Y, Imamura K. Uncommon etiology of Cullen’s sign and Grey Turner sign. J Gen Fam Med. julio de 2022;23(4):282-3.
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Álvarez-García M, Otegui Martínez-Peñuela L, Calvo Hernández R, Porres Cubero J. Uncommon etiology of Cullen sign and Grey Turner sign. 9655/2023


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Publication history

Received: 11/04/2023

Accepted: 19/04/2023

Online First: 12/05/2023

Published: 09/05/2024

Article Online First time: 31 days

Article editing time: 394 days


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