Connect
MJA
MJA

Cullen and Grey Turner signs in abdominal pain

Yoen Young Chuah and Yeong Yeh Lee
Med J Aust 2021; 214 (4): . || doi: 10.5694/mja2.50924
Published online: 1 March 2021

A 46‐year‐old man with a history of chronic hepatitis B and alcohol misuse presented with acute abdominal pain. On physical examination, in addition to jaundice and severe pallor, he had massive ascites and ecchymoses over the periumbilical area, compatible with Cullen sign (Figure, A), and over the lateral flanks, compatible with Grey Turner sign (Figure, B). His haemoglobin level was 33 g/L (reference range, 140–160 g/L) and oesophagogastroduodenoscopy was performed but did not uncover overt bleeding. Subsequent ascitic fluid tapping revealed fresh blood and atypical cells. Computed tomography scan showed multiple nodular enhancements (Figure, C, red arrows) at both lobes of the liver with massive ascites, and contrast extravasation (Figure, C, blue arrows) with fluid density of 83 Hounsfield units at the enhanced nodule at S3, compatible with a ruptured hepatocellular cancer with haemoperitoneum. Cullen and Grey Turner signs suggest intraperitoneal or retroperitoneal haemorrhage, with pancreatitis and trauma being common causes, but are rarely associated with hepatocellular cancer.

  • Yoen Young Chuah1
  • Yeong Yeh Lee2

  • 1 Pingtung Christian Hospital, Pingtung, Taiwan
  • 2 Universiti Sains Malaysia, Kota Bharu, Malaysia


Correspondence: yoenyoungchuah@gmail.com

Competing interests:

No relevant disclosures.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.