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Grey Turner’s sign is a physical exam finding that indicates the presence of underlying bleeding. It is identified by finding bruises located on the flanks or on the lower abdomen, and develops due to bleeding in the region of the body located behind the abdominal cavity. Classically, the sign is associated with a condition called hemorrhagic pancreatitis, although in reality a number of other diseases could cause the sign to develop.
Patients are identified as having the Grey Turner’s sign by finding bruising over the groin, flank, and lower abdomen. Often the bruising is found bilaterally on both sides of the body. The color of the bruising can range from red to yellow to green to purple, depending on how recently the blood appeared in the region. Newer blood typically appears as a red discoloration, but after the body has had time to break down the blood, it causes a green or yellow discoloration. Sometimes affected patients can have some tenderness in the region where the bruising is present, although this is not always the case.
A Grey Turner’s sign develops when blood, typically from the internal organs, escapes from the blood vessels and travels into the layers of tissue located directly under the skin. The proximity of this blood to the surface of the body allows it to be visible to the naked eye. Although most people associate the formation of bruises under the skin with external trauma, the mechanism for the development of bruises that form the Grey Turner's sign is typically caused by internal hemorrhage, instead.
Classically, the most common cause for the development of Grey Turner’s sign is hemorrhagic pancreatitis. In this condition, severe inflammation of the pancreas leads to bleeding from this organ. The blood travels in a posterior and inferior direction, leading to bruising in the lower flanks and inferior abdomen.
Although Grey Turner’s sign is most often associated with hemorrhagic pancreatitis, in reality any form of hemorrhage stemming from the region behind the abdominal cavity can cause this sign. There are a number of other causes of so-called retroperitoneal hemorrhage that can cause this physical exam finding. Examples include rupture of the aorta, ruptured ectopic pregnancies, or bleeding from certain specific parts of the gastrointestinal tract.
The clinical utility of the Grey Turner’s sign is fairly limited for a number of reasons. First, it is considered to have poor sensitivity. In other words, just because the sign is absent doesn’t mean that affected patients don’t have internal bleeding. Actually, only approximately 1 to 2 percent of patients with hemorrhagic pancreatitis develop this sign. Second, the physical exam finding typically does not develop until at least 24 hours after the bleeding has occurred.
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