Cullen and Grey Turner signs !
- Sign
Bruising around the umbilicus (Cullen) or on the flanks (Grey Turner) that points to blood inside or behind the abdomen.
Updated 2026-11-01
See it in 3D: Pancreas · Abdominal aorta · Peritoneum
What it is
These are bruises found on inspection: Cullen sign around the umbilicus and Grey Turner sign on the flanks. They show blood that has tracked from the retroperitoneum or the peritoneal cavity into the subcutaneous tissue. They are rare in acute pancreatitis (fewer than 3% of cases), take one to two days to appear, and go with severe disease and a poor prognosis.
The anatomy it tests
- The pancreas is retroperitoneal; in hemorrhagic pancreatitis blood and its breakdown products spread through the retroperitoneal fascial planes.
- Grey Turner: retroperitoneal blood follows the fascial planes to the subcutaneous tissue of the flanks.
- Cullen: blood reaches the umbilicus along the falciform ligament and the round ligament of the liver, which end at the umbilical region.
How to elicit it
- In good light, uncover the whole abdomen including the flanks, respecting privacy.
- Inspect the umbilicus and periumbilical skin for bluish or purple discoloration.
- Turn the patient gently or look tangentially to see both flanks, between the last rib and the iliac crest.
- Describe the color (recent blue-purple, older green-yellow), extent and side.
- Ask about trauma, anticoagulants, the last menstrual period and how long the pain has lasted.
- Report the finding at once and check vital signs for shock.
What a positive result means
- Positive: periumbilical or flank bruising with no obvious local cause.
- Suggests severe acute pancreatitis, ruptured ectopic pregnancy, ruptured aortic aneurysm, splenic rupture or trauma with retroperitoneal bleeding.
- Linked to high mortality in pancreatitis; it calls for a check for hemodynamic instability.
- Its absence does not rule out severe pancreatitis or bleeding: these signs are rare and late.
Usefulness and limits
- In words: high specificity for a serious process, very low sensitivity.
- Contrast CT defines the cause and extent; in women of childbearing age, a pregnancy test and ultrasound come first.
Test yourself
Think of the answer, then tap the question to see it.
How does Cullen sign differ from Grey Turner sign?
Cullen is periumbilical bruising; Grey Turner is flank bruising. Both point to retroperitoneal or intraperitoneal bleeding.
Why do they not help with early diagnosis of pancreatitis?
They appear 24 to 48 hours after onset and are seen in only a minority of cases.
How does blood reach the umbilicus in Cullen sign?
Along the falciform ligament and the round ligament of the liver, which end at the umbilical region.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Abdominal inspection
- Acute abdomen and peritoneal irritation
- Upper and lower gastrointestinal bleeding
Related conditions
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Acute Pancreatitis - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Cullen's sign (Wikipedia, 2026); Grey Turner's sign (Wikipedia, 2026).
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Representative model, for educational purposes only.