Grey Turnerʼs Sign: A Myth Still Needs to Be Clarified

Abstract

Despite advancements in diagnostic tools, physical signs are still useful indicators for underlying diseases. The use of Grey Turner's sign as a bedside predictor of acute pancreatitis is still controversial among clinicians. In 1912, it was first seen by Grey Turner and postulated that it was fat necrosis due to the escape of pancreatic enzymes into the skin. It is observed in as many as 5% in acute pancreatitis. Here, we present a 40-year-old chronic alcoholic man with acute pancreatitis with Grey Turner' sign. A 40- year- old chronic alcoholic man presented with acute onset of severe vague epigastric pain, radiated to both flanks after binge alcohol drinking overnight. Fourteen hours after admission, the dark blue bruises on both flanks with sharp margin (Grey Turner' sign) were seen. Complete blood count, lipid panel and comprehensive metabolic panels were within reference ranges. Serum amylase was 498 and serum lipase was 1200 .Sonogram (abdomen) showed fatty liver and trace ascites. CT scan (abdomen and pelvis) showed acute pancreatitis without necrosis, peri-pancreatic abscess, pancreatic mass or radiopaque gallstones. He responded with conservative management. Our patient exhibited Grey Turner' sign and was diagnosed with acute pancreatitis from clinical, laboratory and on imaging. While this may not provide a conclusive relationship between Grey Turner's sign and acute pancreatitis, our case certainly illustrates that the presence of Grey Turner' sign may indicate underlying acute pancreatitis .Therefore, patients with Grey Turner's sign should undergo further evaluation for retroperitoneal hemorrhage.1300_A.tif Figure 1: Grey Turner' sign: bluish discoloration of flanks due to acute alcohol induced pancreatitis1300_B.tif Figure 2: Resolving Grey Turner' sign: bluish discoloration of flanks due to acute alcohol induced pancreatitis