History of Present Illness: A 36-year-old male with a history of alcohol abuse, hypertension, hyperlipidemia, and myocardial infarction with a subsequent stent on ticagrelor and aspirin presents with abdominal pain.
He reports 3 days of epigastric and periumbilical pain and multiple episodes of non-bloody, non-bilious emesis. He denies fever, diarrhea, blood in his stool, and urinary symptoms. He endorses bruising to his bilateral flanks and multiple falls recently while drinking.
Vitals: Temp 36.5 °C, HR 142, Resp 22, SpO2 97% , BP 103/65
General: Alert and oriented. Uncomfortable.
Cardiac: Tachycardic, regular rhythm. Tachypneic.
Pulmonary: Normal breath sounds.
Abdominal: Soft abdomen. Epigastric and umbilical abdominal tenderness. No rebound or guarding. Bilateral flank and forearm ecchymoses.
CBC: WBC 12.3, Hgb 15, Hct 43.9, Plt 239
CHEM: Na 136, K 3.4, Cl 101, CO2 26, BUN 9, Cr 0.62, glucose 128, albumin 3.7, total bilirubin 1.9, AST 49, ALT 29, alkaline phosphatase 71, lipase 588
Coags: INR 1.08, PT 12.3, PTT 31.4
Lactic acid: 1.5
Grey Turner’s sign
Described as flank ecchymosis or discoloration classically associated with hemorrhagic pancreatitis
It is nonspecific and may be present in different diseases resulting in retroperitoneal or intra-abdominal hemorrhage.
Peri-pancreatic bleeding results from fat necrosis and inflammation induced by pancreatitis. Blood enters a defect in the transversalis fascia eventually reaching the subcutaneous tissue of the flanks.
In acute pancreatitis, a Grey Turner’s sign suggests high mortality and may be seen with Cullen’s sign (periumbilical bruising).