Cullen's sign for acute haemorrhagic pancreatitis

Abstract

A 25 year old male presented in September 2012 to the Emergency Department of B.J. Medical College, Ahmedabad, India, with complaints of severe chest pain, vomiting and abdominal pain. He was referred to the Department of Medicine. He was chronic alcoholic for the last 10 years with more than 1 litre of country drink per day. He had an irregular haemorrhagic patch on the skin near the umbilicus (Figure), which looked like ‘Cullen's sign’ which is suggestive of intrabdominal bleed. It appears due to collection of blood in subcutaneous tissue around umbilicus. This sign is non-specific and may also be seen in other cases of retroperitoneal bleeds such as acute ruptured ectopic pregnancy or acute abdominal aortic aneurysmal rupture. This sign is seen in approximately 3 per cent of patients and is associated with a mortality of 37 per cent. Clinical evaluation along with biochemical marker of raised amylase and lipase with contrast enhanced (CE) CT abdomen showing heterogeneous enhancement of the pancreatic gland with shaggy contour, blurring of peripancreatic fat planes with the presence of intraperitoneal and retroperitoneal fluid collections confirmed the diagnosis of acute pancreatitis. The patient was managed conservatively and was discharged with counselling for deaddiction of alcohol. Fig. Showing irregular haemorrhagic patch around umbilicus i.e. cullen sign.