Grey Turner's sign
| Grey Turner's sign | |
|---|---|
 | |
| Grey Turner's sign | |
| Differential diagnosis | Acute pancreatitis, ectopic pregnancy |
Grey Turner's sign refers to bruising of the flanks, the part of the body between the last rib and the top of the hip. The bruising appears as a blue discoloration,[1] and is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum, which is a lining of the abdominal cavity. Grey Turner's sign takes 24–48 hours to develop, and can predict a severe attack of acute pancreatitis.[2]
Grey Turner's sign may occur when there is retroperitoneal hemorrhage or intramural bleeding that moves through fascial planes to the subcutaneous areas of the flanks which causes discoloration of the skin.[3] This is commonly associated with severe intra-abdominal pathology such as severe acute pancreatitis. In acute pancreatitis, it can correlate with greater severity, more extensive retroperitoneal hemorrhage and worse prognosis.[4]
Grey Turner's sign may be accompanied by Cullen's sign. Both signs may be indicative of pancreatic necrosis with retroperitoneal or intra-abdominal bleeding.
It may also be associated with a variety of other severe intra-abdominal conditions such as, ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy, and peri-renal hematoma. [5] Interestingly, spontaneous abdominal wall hemorrhages caused by increased intra-abdominal pressure from severe coughing or other inciting events can potentially cause this sign.[6] On visualization, it should prompt urgent evaluation for any possible causes of retroperitoneal bleeding sources. Recognition of this finding can be helpful to prevent unnecessary delay in diagnosis of an underlying cause of this unique hemorrhagic sign. This finding may also represent the need for more intensive care monitoring in severe clinical presentations.[7]
Grey Turner's sign is named after British surgeon George Grey Turner.[8]
Causes
[edit]Causes include
- Acute pancreatitis, whereby methemalbumin formed from digested blood tracks subcutaneously around the abdomen from the inflamed pancreas.
- Pancreatic hemorrhage[1]
- Retroperitoneal hemorrhage[1]
- Blunt abdominal trauma
- Ruptured / hemorrhagic ectopic pregnancy.
- Spontaneous bleeding secondary to coagulopathy (congenital or acquired)
- Aortic rupture, from ruptured abdominal aortic aneurysm or other causes.[1]
History
[edit]It is named after British surgeon George Grey Turner.[8][9]
References
[edit]- ^ a b c d Goldman, Lee (2012). Goldman's Cecil Medicine (24th ed.). Philadelphia: Elsevier Saunders. p. 837. ISBN 978-1437727883.
- ^ Bosmann M, Schreiner O, Galle PR (April 2009). "Coexistence of Cullen's and Grey Turner's signs in acute pancreatitis". Am. J. Med. 122 (4): 333–4. doi:10.1016/j.amjmed.2008.08.032. PMID 19332225.
- ^ Fan, Zhe; Zhang, Yingyi (2017). "Grey Turner's and Cullen's signs induced by spontaneous hemorrhage of the abdominal wall after coughing". Annals of Surgical Treatment and Research. 93 (2): 115–117. doi:10.4174/astr.2017.93.2.115. ISSN 2288-6575. PMC 5566746. PMID 28835889.
- ^ Wong, Enoch; Sayed-Hassen, Akhtar (May 2021). "Grey Turner's sign in severe acute pancreatitis". Clinical Case Reports. 9 (5) e04313. doi:10.1002/ccr3.4313. ISSN 2050-0904. PMC 8143275. PMID 34084525.
- ^ Wong, Enoch; Sayed-Hassen, Akhtar (2021). "Grey Turner's sign in severe acute pancreatitis". Clinical Case Reports. 9 (5): e04313. doi:10.1002/ccr3.4313. ISSN 2050-0904. PMC 8143275. PMID 34084525.
- ^ Fan, Zhe; Zhang, Yingyi (2017). "Grey Turner's and Cullen's signs induced by spontaneous hemorrhage of the abdominal wall after coughing". Annals of Surgical Treatment and Research. 93 (2): 115–117. doi:10.4174/astr.2017.93.2.115. ISSN 2288-6575. PMC 5566746. PMID 28835889.
- ^ Wong, Enoch; Sayed-Hassen, Akhtar (May 2021). "Grey Turner's sign in severe acute pancreatitis". Clinical Case Reports. 9 (5) e04313. doi:10.1002/ccr3.4313. ISSN 2050-0904. PMC 8143275. PMID 34084525.
- ^ a b synd/3347 at Whonamedit?
- ^ Turner, G. Grey (1919). "Local discoloration of the abdominal wall as a sign of acute pancreatitis". British Journal of Surgery. 7 (27): 394–395. doi:10.1002/bjs.1800072711. S2CID 72710780.