Cullen's sign

Overview
Cullen's sign is blue-black bruising of the area around the umbilicus.

Etymology
It is named for Thomas S. Cullen (1869-1953), who was an obstetrician and first described the sign in ruptured ectopic pregnancy in 1916.

Pathophysiology
This sign takes 24-48 hours to appear and predicts a severe attack of acute pancreatitis, with mortality rising from 8-10% to 40%.

It may be accompanied by Grey-Turner's sign (bruising of the flank).

Common Causes
Causes include:
 * acute pancreatitis, where methaemalbumin formed from digested blood tracks around the abdomen from the inflamed pancreas
 * bleeding from blunt abdominal trauma
 * bleeding from ruptured ectopic pregnancy

Skin
Importance of the sign is on a decline since better diagnostic modalities are now available