Biliary collection masquerading as Grey Turner sign

Abstract

Grey turners sign has been conventionally associated with acute pancreatitis; however, this series is a deviation from the traditional paradigm of the former mentioned sign and describes cases of flank discoloration post cholecystectomy performed for varying indications. The aim of study was to highlight correlation between biliary collection and simultaneous flank discoloration. The study describes a series of 3 cases complicated post operatively by flank discoloration, each with different indication, operative procedure, course of events however united by a common factor (biliary collection). Each case was managed on conservative lines i.e. by MgSO4 glycerine dressing. The above-mentioned cases were admitted in male surgical ward in a Tertiary care hospital over a period spanning from April to Oct 2018 whereby they responded to the conservative management albeit varying in duration of recovery and showed a gradual change in discoloration probably reflecting the sequential degradation of haemoglobin in subcutaneous tissue. In contrast to the classically mentioned Grey Turners sign, there was no evidence of pancreatitis but the mere presence of biliary sanguineous collection which tracked to the skin through a breach in transversalis fascia. To conclude, there are many eponyms describing body wall ecchymosis in relation to intra-abdominal or retroperitoneal pathology, however, there is a dearth of data pertaining to association of Grey Turner sign with biliary collection. From the above 3 cases it’s a sign that highlights itself as an index of morbidity than mortality unlike pancreatitis.