Cullen's is periumbilical bruising; Grey Turner's is flank bruising
Mnemonic
“Cullen is the umbilicus, Grey Turner is the flanks”:
- Cullen’s sign - periumbilical bruising
- Grey Turner’s sign - flank bruising
Both indicate retroperitoneal haemorrhage tracking into the subcutaneous tissues, and both take 24 to 48 hours to appear.
Causes are the same for each: severe acute pancreatitis, ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy, splenic rupture, and blunt abdominal trauma.
They are rare, late and non-specific, appearing in perhaps 3 per cent of severe pancreatitis, so they are useful when present but their absence means nothing. Severity is scored with Glasgow-Imrie or APACHE II and the C reactive protein at 48 hours, not by looking for bruises.
Fox’s sign is the related one, bruising over the inguinal ligament from the same mechanism.
Expansion
- Cullen’s sign - bruising around the umbilicus. Blood tracks along the falciform ligament and the round ligament to the umbilicus
- Grey Turner’s sign - bruising in the flanks. Blood tracks from the retroperitoneum through the fascial planes to the subcutaneous tissue of the flank
Both indicate retroperitoneal haemorrhage. Causes include:
- Severe acute pancreatitis - the classic association
- Ruptured abdominal aortic aneurysm
- Ruptured ectopic pregnancy
- Blunt abdominal trauma
Both are late signs, typically appearing 24 to 48 hours after the onset of bleeding, and are present in only a small minority of cases. Their absence therefore means nothing, but their presence indicates severe disease and a poor prognosis.