A 12-year-old boy presents to you with abdominal pain

intra-abdominal/retroperitoneal hemorrhage

Educational Objective:

Recognize intra-abdominal/retroperitoneal hemorrhage findings on physical examination.

Key Point:

Bluish discoloration or ecchymosis of the flank or around the umbilicus can indicate intra-abdominal/ retroperitoneal hemorrhage.

Explanation:

The Cullen sign (bluish discoloration about the umbilicus) and Grey Turner sign (bluish discoloration or ecchymosis of the abdominal wall or flank) are unusual findings suggestive of intra-abdominal/retroperitoneal hemorrhage. You may have to turn the patient to see the Turner sign. These signs are due to dissection of blood along the fascial planes. Causes include hemorrhagic pancreatitis, trauma, ruptured ectopic pregnancy (not in this case, obviously), and ruptured aneurysm, among others.

References:

Harris S, Naina H. Cullen’s sign revisited. Am J Med. 2008;121(8):682-683.

Rahbour G, Ullah M, Yassin N, Thomas G. Cullen’s sign – case report with a review of the literature. Int J Surg. 2012;3(5):143-146.

Werlin S, Wilschanski M. Pancreatitis. In: Kliegman R, et al, eds. Nelson Textbook of Pediatrics. 20th ed., 2016.