Grey Turner' s Sign

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Figure 1. Grey Turner's Sign.

Ecchymosis or bruising on the abdomen is rarely a good sign on physical exam. Grey Turner's sign is bilateral flank bruising or ecchymosis and is a classic finding of bleeding into the retroperitoneum around the kidneys and pancreas.   It is associated with severe acute pancreatitis but may occur following cardiac catheterization with bleeding into the retroperitoneum.

Unfortunately, abdominal wall bruising is common and not always Grey Turner's sign.  Location of the bruising really matters.  In blunt trauma (e.g. high speed motor vehicle accident), the classic "seat belt sign" is an indicator of potential intra-abdominal injury.    Physicians can easily be mislead by subcutaneous injection of insulin or blood thinning medications (e.g. low-molecular weight heparin).  These medications can result in impressive abdominal wall bruising that is usually self-limited.

Dr. George Grey Turner was born September 8, 1887 in North Shields, England.  As a young surgeon, he traveled extensively throughout America, Canada, and Africa.  He was a pioneer in cancer surgery of the esophagus.  In  1920, Dr. Grey Turner reported his experience with two patients that died after abdominal exploration for acute pancreatitis.  From his experience, he noted periumbilical discoloration (Cullen's sign) and bilateral flank discoloration.  He hypothesized that the discoloration was "direct action of pancreatic juice."

Figure 2. Image from original report by Dr. Grey Turner.

Reference:
White H. An Outstanding ISS/SIC Surgeon: George Grey Turner. World Journal of Surgery. 2003. 27:511-513.

Turner G. Local Discoloration of the Abdominal Wall as a Sign of Acute Pancreatitis. British Journal of Surgery. 1920. 7:394-395.