Cullen's sign associated with metastatic esophageal carcinoma

Abstract

Cullen's sign refers to the presence of periumbilical ecchymosis and is most often recognized as a manifestation of hemorrhagic pancreatitis. However, lesser‐appreciated etiologies include ruptured ectopic pregnancy, leaking aortic aneurysm, and intraabdominal malignancy. We report the case of a patient with metastatic adenocarcinoma of the esophagus who developed Cullen's sign shortly before death. Based on this case and previously reported cases, malignancy‐associated Cullen's sign portends a dismal prognosis, and may be considered a pre‐terminal finding. Journal of Hospital Medicine 2008;3:277–278. © 2008 Society of Hospital Medicine.

Umbilical Complications of Malignancy

“…However, Cullen's sign has been reported in association with neoplastic liver disease such as hepatocellular carcinoma, esophageal carcinoma, thyroid carcinoma, and non-Hodgkin's lymphoma [27][28][29][30]. Proposed mechanisms of periumbilical ecchymosis include blood tracking along the falciform ligament from intrahepatic tumor hemorrhage or hemorrhagic ascites [27,28]. The prognosis of malignancy-associated Cullen's sign is dismal, with death occurring shortly after the appearance of periumbilical hemorrhage in all reported cases [28].…”

“…Acute hemorrhagic pancreatitis is the most well-known etiology of Cullen's sign and may occur in association with ecchymotic staining of the flanks, known as Grey-Turner sign [27,28]. Any process resulting in intraabdominal bleeding such as ruptured ectopic pregnancy, leaking abdominal aortic aneurysm, or hemoperitoneum resulting from blunt abdominal trauma may result in periumbilical ecchymosis [28].…”

“…Proposed mechanisms of periumbilical ecchymosis include blood tracking along the falciform ligament from intrahepatic tumor hemorrhage or hemorrhagic ascites [27,28]. The prognosis of malignancy-associated Cullen's sign is dismal, with death occurring shortly after the appearance of periumbilical hemorrhage in all reported cases [28].…”

“…Any process resulting in intraabdominal bleeding such as ruptured ectopic pregnancy, leaking abdominal aortic aneurysm, or hemoperitoneum resulting from blunt abdominal trauma may result in periumbilical ecchymosis [28]. However, Cullen's sign has been reported in association with neoplastic liver disease such as hepatocellular carcinoma, esophageal carcinoma, thyroid carcinoma, and non-Hodgkin's lymphoma [27][28][29][30]. Proposed mechanisms of periumbilical ecchymosis include blood tracking along the falciform ligament from intrahepatic tumor hemorrhage or hemorrhagic ascites [27,28].…”

“…Acute hemorrhagic pancreatitis is the most well-known etiology of Cullen's sign and may occur in association with ecchymotic staining of the flanks, known as Grey-Turner sign [27,28]. Any process resulting in intraabdominal bleeding such as ruptured ectopic pregnancy, leaking abdominal aortic aneurysm, or hemoperitoneum resulting from blunt abdominal trauma may result in periumbilical ecchymosis [28]. However, Cullen's sign has been reported in association with neoplastic liver disease such as hepatocellular carcinoma, esophageal carcinoma, thyroid carcinoma, and non-Hodgkin's lymphoma [27][28][29][30].…”