Grey Turner's sign in severe acute pancreatitis.

Grey Turner's sign is a well described butrarely seen sign usually indicating severe intra-abdominal pathology. Classically it is associated with severe acute pancreatitis but can beassociated with a number of other severe intra-abdominal conditions.

CASE REPORT

A 61‐year‐old man with a history of hypertension presented with upper abdominal pain and vomiting on a background of recent ingestion of alcohol. On examination, there was upper abdominal tenderness and bruising was noted in the flank (Figures 1,2) consistent with Grey Turner's sign which spontaneously resolved after 48 hours. An elevated lipase confirmed a diagnosis of pancreatitis. Initially, the patient was stable but rapidly deteriorated with multi‐organ failure requiring intensive care support. He developed severe necrotizing pancreatitis but ultimately made a good recovery following a prolonged admission to hospital.

FIGURE 1

Ecchymosis in the right flank consistent with Grey Turner's sign

FIGURE 2

Extent of ecchymosis seen in right flank

Described as discoloration of the flank, Grey Turner's sign is a rarely seen clinical sign. Classically, it is associated with severe acute pancreatitis but can be associated with a number of other conditions causing retroperitoneal bleeding such as ruptured abdominal aortic aneurysm. Other reported conditions associated with this sign include peri‐renal hematoma and ruptured ectopic pregnancy. Its presence suggests severe intra‐abdominal pathology, and its appearance is caused by hemorrhage with subsequent breakdown of red blood cells.

Grey Turner's sign can be easily missed due to a failure of recognition with many clinicians not having seen this sign firsthand. Early identification of this sign can alert clinicians to severe underlying pathology.

CONFLICT OF INTEREST

There are no conflicts of interest to disclose.

AUTHOR CONTRIBUTIONS

EW: contributed to the development, literature search, writing of the report, providing relevant images, and editing of the report. ASH: contributed to the development and editing of the report. All authors have approved the final version.

INFORMED CONSENT

The patient has provided written informed consent for the publication of this image and article.