Cullen Sign

Cullen sign is caused by bleeding within or behind the peritoneum. A variety of conditions may result in hemorrhage within the abdomen. The most common cause is acute pancreatitis, which may cause both Cullen and Grey Turner signs. In contrast to Cullen sign, Grey Turner sign describes the discoloration and ecchymoses of the bilateral flanks. A patient with a ruptured ectopic pregnancy (i.e., bleeding from a fertilized egg that attaches outside the uterus) may also have a positive Cullen sign.

Gastrointestinal disorders, such as a perforated duodenal ulcer (i.e., hole in the small intestine from an ulcer), ruptured spleen, amoebic liver abscess (i.e., area of pus surrounding the liver due to an infectious organism), a ruptured common bile duct, percutaneous liver biopsy (i.e., using a needle to take a liver sample), hepatocellular carcinoma (i.e., liver cancer), and hepatic lymphoma (i.e., liver tumor), may cause bleeding within the abdomen. 

In addition, a ruptured aortic aneurysm (i.e., tear in dilated aorta) or a ruptured internal iliac artery aneurysm (i.e., tear in dilated groin artery) can hemorrhage into the abdomen to cause a positive Cullen sign. 

Other causes may include severe trauma, metastatic cancer, ovarian cysts (i.e., fluid-filled sacs on the ovary), metastatic esophageal cancer, post-radiologic intervention (i.e., complication from the image-guided procedure) or coagulopathy (i.e., bleeding disorder). 

In summary, the Cullen sign signifies bleeding within the abdomen. Further testing and imaging may be conducted to differentiate the underlying cause.