Cullen Sign in Pancreatitis

A 72-year-old woman with acute abdominal pain and vomiting was brought to the hospital. The patient had no significant medical history and was taking no medications.

Rebound sensitivity was absent. Leukocytosis was noted (white blood cell count, 16,000/µL); lactate dehydrogenase level was 400 U/L; alanine aminotransferase and aspartate aminotransferase levels exceeded 250 U/L; and serum glucose level was 450 mg/dL. An abdominal ultrasonogram revealed edema of the head of the pancreas. Drs N. K. Akritidis, D. Eftaxias, G. Dimos, and F. Apostolou of Ioannina, Greece, diagnosed acute pancreatitis attributable to cholelithiasis.

Intravenous fluid therapy (dextrose, 5%, and normal saline, sodium chloride 0.9%, 4 L/d) and meperidine were given. Because cultures of the patient's blood were negative and her condition was stable, antibiotics were not prescribed.

Forty-eight hours after admission, the laboratory findings remained unchanged. These data and the patient's age fulfill only 4 of the 11 Ranson criteria for severity of pancreatitis and predict a good prognosis.

Four days after admission, the Cullen sign-an area of skin bruising around the umbilicus-developed. The Cullen sign, characteristic of hemorrhagic acute pancreatitis, occurs in a small number of affected patients. Its presence is not of prognostic significance.

This patient was given somatostatin and discharged from the hospital after 10 days. Her recovery continued uneventfully with an excellent outcome.