Abdominal wall hemorrhage has been reported after trauma, subcutaneous drug injection, and paracentesis, and it has been reported to occur spontaneously during pregnancy and biliary tract disease. However, the first description of isolated periumbilical discoloration as a result of intra-abdominal pathology was made by American surgeon Joseph Louis Ransohoff in 1906 in his account of a 53-year-old man with a ruptured common bile duct and bile peritonitis.
8 Ransohoff wrote,
Six years later, Grey Turner reported the observation of “a bluish color appearance of the abdominal wall surrounding the umbilicus” in a 54-year-old woman with acute pancreatitis.
9 He later described abdominal wall discoloration of the flanks in a 53-year-old man with acute pancreatitis, as follows
9:
In 1918, Cullen presented a paper entitled, “A new sign in ruptured extrauterine pregnancy,”
10 in which he reported periumbilical “bluish-black” discoloration in a 38-year-old woman in association with a ruptured ectopic pregnancy. Although it is historically associated with ruptured ectopic pregnancy, Cullen sign has also been described in association with acute pancreatitis and other clinical conditions such as rectus sheath hematoma,
11 splenic rupture in infectious mononucleosis,
12 portal hypertension,
13 amoebic liver abscess,
14 metastatic thyroid cancer,
15 metastatic esophageal cancer,
16 and non-Hodgkin lymphoma.
17 Current prominent clinical manuals such as
Harrison’s Principles of Internal Medicine and
Cecil’s Textbook of Internal Medicine describe both Cullen sign and Grey Turner sign in association with severe acute pancreatitis, and it is now customary for medical students, resident physicians, and attending physicians to associate one with the other.