Cullen's sign

Cullen's sign is blue-black bruising of the area around the umbilicus.

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Thomas. S. Cullen (1869-1953) was an obstetrician and first described the sign in ruptured ectopic pregnancy in 1916.

This sign takes 24-48 hours to appear and predicts a severe attack of acute pancreatitis, with mortality rising from 8-10% to 40%.

It may be accompanied by Grey-Turner's sign (bruising of the flank).

Causes

Causes include:

• acute pancreatitis, where methaemalbumin formed from digested blood tracks around the abdomen from the inflamed pancreas
• bleeding from blunt abdominal trauma
• bleeding from ruptured ectopic pregnancy

Importance of the sign is on a decline since better diagnostic modalities are now available