Grey Turner sign

Description

Grey Turner sign: atraumatic abdominal ecchymosis, in particular – bruising of the flanks. George Grey Turner reported a ‘dirty-green‘ discolouration on both loins of a patient with acute pancreatitis (confirmed on operation)

  • Incidence of 3-5% in patients with acute pancreatitis, associated with increased mortality (30-40%) and increased risk of pseudocyst formation. [Surg Gynecol Obstet. 1984]
  • CT scanning has helped to define the anatomic pathway by which extravasated pancreatic enzymes and their effects lead to these cutaneous discolorations. [Pancreas. 1998.].
  • Extraperitoneal diffusion is from the anterior pararenal space between the two leaves of the posterior renal fascia and then to the lateral edge of the quadratus lumborum muscle.
  • Communication may then extend to the posterior pararenal space and the structures of the flank wall. The lumbar triangle, a site of anatomic weakness on the flank wall, provides an external window into the internal proteolytic events.

History

George Grey Turner (1877–1951) was an English surgeon

1920 – Published paper on ‘Local discoloration of the abdominal wall as a sign of acute pancreatitis‘ citing two cases of acute pancreatitis with fat necrosis and retroperitoneal haemorrhage – Grey Turner sign

The first case from 1912 concerned a 54 year old female with three days of abdominal pain presenting with an area of discoloration (a bluish colour), about 6 inches in diameter involving the abdominal wall surrounding the umbilicus.

the patient suffered from acute pancreatitis, with much effusion into the peritoneal cavity. She lived nine days after operation, and the post-mortem examination disclosed a sloughing pancreas with much fat necrosis

The second case from 1917 promoted the publication. “In a cursory examination of the voluminous literature on pancreatitis I have not observed any mention of this sign

The tenderness over the gall-bladder region was very marked, and I now noticed two large discoloured areas in the loins. They were about the size of the palm of the hand, slightly raised above the surface, and of a dirty-greenish colour.

Grey-Turners-Sign-Original-Photo-1919-COLOR
Image of Grey Turners Sign: Original Photo: 1917. Colourised: Ercleve T. 2018
Alternate causes for Grey Turner Sign
CauseReference
Intra-aortic balloon pump insertionRob, Williams 1961
Cardiac catheterizationArmour et al 1978
Sclerosing peritonitisPryor et al 2001
Rectus sheath hematomaGuthrie, Stanley 1996
Ruptured abdominal aortic aneurysmArmour et al 1978
Retroperitoneal necrotizing fasciitisPryor et al 2001
Ischemic and gangrenous bowelKelley ML 1961
Bilateral acute salpingitis with IUPOrient JM, Sapira JD 2005
Acute PancreatitisBosmann et al 2009

Epperla N et al. A Review of Clinical Signs Related to Ecchymosis. WMJ • APRIL 2015


Associated Persons


Alternative names

  • Grey Turner’s sign

Controversies

  • The topographic location of the ecchymosis of Grey Turner and Cullen do not point to the aetiology with any degree of certainty.
  • Grey Turner sign and Cullen sign may occur simultaneously, especially in patients with retroperitoneal haemorrhage.

References


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the names behind the name

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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