Bryant's and Stabler's Signs after a Difficult Delivery

Abstract

A neonate presented after birth with scrotal and right inguinal ecchymosis. He had been born at term after a difficult vaginal delivery that ultimately required both fundal pressure and vacuum extraction. The thorax was not manipulated during birth. Despite the challenging delivery, the physical examination at birth was normal. A few hours later, however, the child appeared to be in discomfort, with moaning, and was newly noted to have cyanosis. Reexamination revealed ecchymosis of the scrotum and right inguinal region (Panel A). Laboratory results showed a decrease in the hematocrit from 41.2% at birth to 32.5%, normal measures of blood coagulation, and slightly elevated liver enzymes. Ultrasonography revealed three subcapsular lacerations of the liver (in the quadrate lobe and in segments 5 through 7). This case demonstrates an example of Bryant's sign (scrotal ecchymosis) and Stabler's sign (inguinal ecchymosis) caused by retroperitoneal hemorrhage. In this case, the retroperitoneal bleeding was caused by a perinatal liver laceration. The infant required no specific intervention and was discharged home after 1 week, with improvement of the inguinal ecchymosis (Panel B). Follow-up after 1 month revealed no remaining ecchymosis (Panel C).

Newborn With Supraumbilical and Scrotal Bruising

“…Blood can spread to the periumbilical area through the falciform and round ligaments (Cullen's sign) 1 and into the scrotum through the spermatic cord (Bryant's sign). 2 Hemorrhage originating from the liver, adrenal glands, and spleen or other sources may rarely produce perinatal hemoperitoneum following operative labor, asphyxia, and resuscitation. [1][2][3][4] Cullen's and Bryant's signs may appear late.…”

“…2 Hemorrhage originating from the liver, adrenal glands, and spleen or other sources may rarely produce perinatal hemoperitoneum following operative labor, asphyxia, and resuscitation. [1][2][3][4] Cullen's and Bryant's signs may appear late. 3,4 Hemoperitoneum is typically managed observationally, but hemodynamically unstable infants may require surgery.…”

Bryant Sign in an Elderly Woman

“…Bowels herniated into the patent processus vaginalis can become strangulated and ischemic. Labia majora ecchymosis (female version of Bryant sign (scrotal ecchymosis)) is seldom mentioned in the literature. Herein is reported a strangulated indirect inguinal hernia with the presentation of Bryant sign in an elderly woman.…”