Dấu hiệu Cullen

Mô tả: Peri-umbilical ecchymoses.

Nguyên nhân: More common • Retroperitoneal bleeding • Post surgery • Iatrogenic – anticoagulation complication, postoperative • Rectus sheath haematoma Less common • Ectopic pregnancy • Intrahepatic haemorrhage • Ischaemic bowel • Ruptured abdominal aortic aneurysm • Amoebic liver cyst • Perforated duodenal ulcer

Cơ chế: The final common pathway in most The retroperitoneum is connected to the gastro-hepatic ligament and then to the falciform ligament and finally to the round ligament (the obliterated umbilical vein), which tracks to the abdominal wall around the umbilicus. When a haemorrhage (from any cause) occurs, blood is able to move along these ligaments to the abdominal wall to produce ecchymoses.29

Ý nghĩa lâm sàng: Although often still taught as being a sign of pancreatitis, Cullen’s sign is very non-specific. In fact, in a study of 770 cases of pancreatitis,30 only 9 patients exhibited Cullen’s sign. Similarly, its association with ectopic pregnancy is now very rare. It is a relatively specific sign for retroperitoneal bleed so, if seen, it does warrant investigation. However, its absence does not exclude significant underlying pathology.