From the Research
The Cullen sign is a bluish discoloration around the umbilicus (belly button) that indicates internal bleeding in the abdomen, particularly from acute hemorrhagic pancreatitis or a ruptured ectopic pregnancy. This sign appears when blood from internal bleeding tracks through tissue planes to the umbilical area, creating visible bruising. It typically takes 24-48 hours to develop after the initial bleeding begins. Cullen sign is often accompanied by Grey Turner sign (bruising on the flanks), and together they suggest severe intra-abdominal hemorrhage. When observed, Cullen sign requires immediate medical attention as it indicates a potentially life-threatening condition. The underlying mechanism involves blood breaking down into hemoglobin, which is then metabolized, causing the characteristic blue-purple discoloration. This physical finding is named after Thomas Stephen Cullen, who first described it in ectopic pregnancy cases, though it's now recognized in various conditions involving intraperitoneal bleeding.
Key Points
- The Cullen sign is a specific physical finding that indicates internal abdominal bleeding.
- It is characterized by a bluish discoloration around the umbilicus.
- The sign typically develops 24-48 hours after the initial bleeding begins.
- Cullen sign is often accompanied by Grey Turner sign, which suggests severe intra-abdominal hemorrhage.
- Immediate medical attention is required when the Cullen sign is observed, as it indicates a potentially life-threatening condition.
Clinical Implications
The Cullen sign is an important physical finding that requires prompt recognition and management. Clinicians should be aware of the sign's association with internal abdominal bleeding and its potential to indicate a life-threatening condition. When the Cullen sign is observed, clinicians should immediately initiate further evaluation and treatment to address the underlying cause of the bleeding. This may involve imaging studies, laboratory tests, and surgical intervention, as necessary. The Cullen sign is a critical component of the physical examination in patients with suspected abdominal bleeding, and its recognition can help guide timely and effective management 1, 2.