Cullen's sign

Cullen's sign is a medical term that refers to the appearance of superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. It is a physical sign that suggests intra-abdominal bleeding, which may result from a variety of causes, including pancreatitis, ectopic pregnancy, or trauma. The sign is named after Thomas Stephen Cullen (1869–1953), a Canadian gynecologist who first described it in 1918.

Causes

Cullen's sign may be observed in several conditions, most notably:

• Acute pancreatitis: This is the inflammation of the pancreas, which can lead to bleeding within the abdominal cavity, manifesting as Cullen's sign.
• Ectopic pregnancy: A pregnancy that occurs outside the uterus, typically in a fallopian tube, can rupture, leading to internal bleeding and the appearance of Cullen's sign.
• Traumatic injury: Any trauma that leads to internal bleeding near the umbilicus can result in Cullen's sign.
• Other causes may include gastrointestinal bleeding, ruptured abdominal aortic aneurysm, and malignancies that lead to peritoneal bleeding.

Pathophysiology

The underlying mechanism of Cullen's sign involves the seepage of blood from the internal bleeding site to the subcutaneous tissue around the umbilicus. The blood tracks along the fascial planes and peritoneal ligaments, eventually reaching the subcutaneous tissue. The degradation of hemoglobin in the accumulated blood leads to the characteristic blue or purple discoloration observed in Cullen's sign.

Diagnosis

The presence of Cullen's sign is an indication for further diagnostic evaluation to identify the source of internal bleeding. This may include:

• Abdominal ultrasound: To assess for free fluid or organ injury within the abdomen.
• Computed tomography (CT) scan: Provides detailed images of the abdominal organs and can identify the site of bleeding.
• Magnetic resonance imaging (MRI): Used in certain cases where CT scan is contraindicated or to provide more detail in specific areas.
• Laboratory tests: Including complete blood count (CBC), liver function tests, and amylase and lipase levels, to evaluate for pancreatitis and other potential causes of bleeding.

Treatment

Treatment of Cullen's sign involves addressing the underlying cause of the bleeding. This may include:

• Surgical intervention: In cases of ectopic pregnancy, ruptured organs, or other conditions requiring immediate surgery.
• Medical management: For conditions like pancreatitis, where supportive care and treatment of the underlying inflammation may be sufficient.
• Blood transfusions: May be necessary to replace lost blood volume and treat shock.

Prognosis

The prognosis for patients presenting with Cullen's sign depends on the underlying cause and the timeliness of intervention. Early detection and treatment of the source of bleeding are crucial for a favorable outcome.

See also

• Grey Turner's sign
• Fox's sign
• Hemoperitoneum