- hemorrhagic pancreatitis
- ruptured aortic aneurysm
- ruptured ectopic pregnancy
Both the Grey Turner sign and the Cullen sign (card AB-002) are thought to result from the
tracking of blood-stained retroperitoneal fluid through the tissues of the abdominal wall or along
the falciform ligament to the umbilical area. We will refer to them collectively as body wall
In a series of 23 patients with BWE (representing 3% of 770 consecutive patients
hospitalized for pancreatitis), the mean age was 56 (range, 20 to 83); 75% were women, and all
major causes of pancreatitis were represented. BWE appeared most commonly on the fourth
hospital day (range, 2 to 6); 40% had the Cullen sign, 40% the Grey Turner, and 20% had
By objective criteria, 87% of those with BWE had "severe" pancreatitis, and 96% suffered
"serious" complications; 37% died, but the presence of BWE was not an independent risk factor
for death. Age, however, was important: Those with BWE who were under age 54 all survived,
while those over 70 all died soon after the sign appeared. Of those surviving longer than 5 days,
37% developed pseudocysts.3
(1) Br J Surg. 7:394-395 (1919). Turner's original description. (Grey was his middle name.)
(2) JAMA. 247:2754 only (1982). Large color photo.
(3) Surg Gynecol Obstet. 159:343-347 (1984). Study from Scotland. Also see card TH-007.
Zebra Cards: An Aid to Obscure Diagnoses. JG Sotos. Philadephia: American College of Physicians, 1989. ISBN 0-943126-13-4. Copyright © 1989 American College of Physicians. All Rights Reserved. Phone: 1-800-523-1546.