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Clinical Summary

Bluish to purplish periumbilical discoloration (Cullen sign) and flank discoloration (Grey Turner sign) represent retroperitoneal hemorrhage that has dissected through fascial planes to the skin. Retroperitoneal blood may also extravasate into the perineum, causing a scrotal hematoma or inguinal mass. This hemorrhage may represent a hemodynamically significant bleed.


Grey Turner and Cullen Signs. This patient displays both flank and periumbilical ecchymoses characteristic of Grey Turner and Cullen signs. (Photo contributor: Michael Ritter, MD.)

Cullen sign and Grey Turner sign are most frequently associated with hemorrhagic pancreatitis, are seen in 1% to 2% of cases, and typically are seen 2 to 3 days after onset. These signs may also be seen in ruptured ectopic pregnancy, severe trauma, leaking or ruptured abdominal aortic aneurysm, coagulopathy, or any other condition associated with bleeding into the retroperitoneum.

Management and Disposition

Initial treatment of hemodynamically unstable patients with Grey Turner sign or Cullen sign includes resuscitation with crystalloid and blood products. Laboratory studies (CBC, amylase, lipase, human chorionic gonadotropin, prothrombin time [PT]/international normalized ratio [INR], blood type and crossmatch) and diagnostic imaging (POCUS and contrast-enhanced CT of the abdomen/pelvis) should occur simultaneously with resuscitation to identify the cause of the bleeding. Because of the severity of diseases associated with Grey Turner and Cullen signs, these patients are usually admitted to the hospital.


  1. Mortality rate in patients with Cullen or Grey Turner sign may be as high as 37%.

  2. These signs are typically seen 2 to 3 days after the acute event.

  3. These signs are seen in only 1% to 2% of patients with hemorrhagic pancreatitis.


Grey Turner Sign. A 68-year-old man with flank ecchymosis due to hemorrhagic pancreatitis. (Photo contributor: Stephen W. Corbett, MD.)

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