Cullen Sign

Original Editor - Umamah Ejaz
Top Contributors - Umamah Ejaz

Introduction

Ectopic Pregnancy

Cullen's sign is named after Thomas S. Cullen (1868–1953), a Canadian gynecologist who extensively researched gynecological diseases, including uterine cancer and ectopic pregnancy. He later became a professor at Johns Hopkins Hospital. Cullen first described this sign in 1918 after encountering a case of ruptured extrauterine pregnancy.

Purpose

A Cullen’s sign is characterized by superficial edema and bruising in the subcutaneous fatty tissue around the periumbilical region, also known as periumbilical ecchymosis. It is most commonly associated with hemorrhagic pancreatitis.

The sign typically appears 24 to 72 hours after the onset of bleeding, serving as a late but significant clinical indicator of intra-abdominal hemorrhage. Although not specific to a single condition, it may assist in diagnosing acute pancreatitis, ruptured ectopic pregnancy, and other serious abdominal pathologies.

Signs and Symptoms

Cullen's sign

Bruising Around the Navel:

• Discoloration from pale yellow to dark purple.

Common Symptoms:

• Abdominal pain, tenderness, and swelling.

Other Possible Signs:

• Bloating
• Nausea or vomiting
• Diarrhea
• Hiccups
• Indigestion
• Fever
• Rapid heartbeat
• Jaundice (yellow skin and eyes)
• Clay-colored stools

Cullen’s sign may indicate internal bleeding and requires urgent medical attention.

Assessment

• Patient Positioning:

Place the patient in a supine position and ensure full abdominal exposure for proper assessment.

• Visual Inspection:

Observe the periumbilical region for discoloration ranging from pale yellow to dark purple, indicating hemorrhage severity and duration.

• Palpation:

Gently assess for tenderness, swelling, or an underlying mass to evaluate the extent of tissue involvement.

The below video shows about the Cullen sign.

Evidence

Cullen's sign, marked by periumbilical ecchymosis, is a rare clinical finding with limited sensitivity and specificity for diagnosing intra-abdominal conditions. In a retrospective study of 519 patients with acute pancreatitis, it was observed in only 0.77% of cases, demonstrating low sensitivity.

Likewise, in a review of 6,063 ectopic pregnancy cases, it appeared in just 0.06% of patients. Given its low prevalence and lack of diagnostic accuracy, Cullen's sign should not be relied upon as a primary clinical indicator. Instead, a thorough evaluation—including medical history, physical examination, and appropriate imaging—remains essential for accurate diagnosis.