A Variant of the Hofstätter–Cullen Sign in Intra-Abdominal Hemorrhage from Ectopic Pregnancy

Cullen's Sign

“…Operation, however, revealed a haemoperitoneum with no evidence of subperitoneal haemorrhage. The case reported by Fallon and Manning (1949) was very similar, and they claimed that at operation " no anomalies were noted inside the abdominal wall." In both these cases, however, it is possible that extraperitoneal blood was not seen at operation because it had by then seeped away, as in Case 1 described above.…”

“…The operative findings of Stabler (1934) and Way (1941) showed that the skin discoloration was due to blood in the subcutaneous tissue, as in an ecchymosis. In the same way, therefore, as in this latter condition, the exact colour of the sign may vary (Jackson, 1922;Neumann, 1928;Fallon and Manning, 1949). The abnormal staining of the subcutaneous tissue need not be confined to the umbilicus (Neumann, 1928;Stabler, 1934;Fallon and Manning, 1949), and may even involve previous abdominal operation scars (Gold, 1926;Schmitz, 1932;Smith and Wright, 1935).…”

“…The abnormal staining of the subcutaneous tissue need not be confined to the umbilicus (Neumann, 1928;Stabler, 1934;Fallon and Manning, 1949), and may even involve previous abdominal operation scars (Gold, 1926;Schmitz, 1932;Smith and Wright, 1935). In all, it has been possible to trace about 30 reported cases of Cullen's sign associated with ruptured tubal pregnancy, though Fallon and Manning (1949) claim to have found 70 such instances.…”