Grey Turner sign is a medical observation characterized by discoloration on the body, indicating internal bleeding. It is an uncommon, visible manifestation of hemorrhage within the abdomen, particularly in the retroperitoneal space. Its presence suggests that blood has tracked from deeper areas to the skin surface.
Appearance and Characteristics
Grey Turner sign presents as a distinct ecchymosis, or bruising, visible on the flanks of the body. The flanks are the soft parts of the body between the last rib and the top of the hip. This discoloration can appear on one side or both, depending on the extent and location of the internal bleeding.
The color of the bruising typically ranges from a bluish-purple hue, but it can also manifest as red, green, or yellow. These color variations depend on the stage of red blood cell breakdown within the tissues, similar to how a common bruise changes over time.
The sign does not appear immediately; it usually takes about 24 to 48 hours to develop after the onset of the acute underlying event. This delay occurs because blood needs time to track from the deep retroperitoneal space along anatomical planes to the superficial subcutaneous tissue of the flank.
Underlying Causes
Grey Turner sign is most commonly associated with severe acute necrotizing pancreatitis, a serious inflammation of the pancreas. In such cases, pancreatic enzymes can cause damage and bleeding within the abdominal cavity, leading to blood accumulating around the pancreas.
Beyond pancreatitis, the sign can indicate other conditions involving retroperitoneal hemorrhage (bleeding behind the abdominal lining). These include a ruptured abdominal aortic aneurysm, a life-threatening condition where the main artery in the abdomen tears. Ruptured ectopic pregnancies, where a fertilized egg implants outside the uterus and causes internal bleeding, can also lead to this sign. Additionally, spontaneous bleeding in individuals on anticoagulation therapy, blunt abdominal trauma, or even a ruptured spleen may result in the appearance of Grey Turner sign.
Significance and Urgency
Grey Turner sign indicates significant intra-abdominal or retroperitoneal hemorrhage. It is often associated with severe, potentially life-threatening medical conditions requiring immediate attention. For instance, in cases of acute pancreatitis where this sign is observed, mortality rates can be as high as 30% to 40%.
Recognizing this discoloration on the flanks should prompt an urgent medical evaluation. Individuals observing this sign in themselves or others should seek emergency medical care without delay. Prompt medical intervention is essential, as the underlying bleeding may require urgent surgical treatment to control the hemorrhage and address the root cause. Initial medical management typically involves stabilizing the patient through fluid resuscitation and other supportive measures while diagnostic tests are performed to identify the source of bleeding.