Cullen Sign

What is Cullen sign?

Cullen sign (periumbilical ecchymosis) is a term healthcare providers use to describe bruises and swelling in skin around your belly button (umbilicus). Providers consider Cullen sign a medical emergency. It means you have sudden, severe bleeding in your abdominal cavity.

The bruising may look different depending on the reason why you have peritoneal bleeding and how much bleeding the condition causes. For example, mild bleeding can cause bruising that’s yellow in color.

More severe bleeding causes darker bruises. Bruising in Cullen sign may be brown, black, dark blue or purple. The bruises may be painful to the touch.

You may have bleeding if you take a hard hit to your belly, or you have a disease that causes it. Regardless of the cause, you should go to the emergency room or call 911 (or your local emergency service number) if you see bruises and swelling around your belly button.

What are the most common causes of Cullen sign?

Cases involving Cullen sign are rare. Healthcare providers often link Cullen sign with acute necrotizing pancreatitis or ruptured ectopic pregnancy. Cullen sign may be one of several symptoms. For example, severe necrotizing pancreatitis may cause symptoms, including:

• Abdominal distension
• Chills and fever
• Nausea and vomiting
• Upper abdominal pain that may spread to your back
• Tachycardia (heart beating faster than usual)

Ruptured ectopic pregnancy symptoms may include:

• Pain in your lower abdomen, back or pelvis
• Dizziness or weakness
• Fainting

These conditions can cause life-threatening bleeding in your belly. Cullen sign may be a symptom of other conditions, such as:

• Abdominal trauma from an injury
• Amebiasis (amoebic dysentery)
• Non-Hodgkin lymphoma that causes a ruptured spleen
• Rectus sheath hematoma (bleeding in connective tissues in your abdomen)
• Ruptured abdominal aorta
• Strangulated umbilical hernia

How is Cullen sign treated?

There’s no treatment for Cullen sign, but there are treatments for the conditions that cause it. Your treatment will depend on the underlying condition. Healthcare providers may treat internal bleeding with:

• Blood transfusions
• IV fluids (through a vein in your arm)
• Surgery

When do you see Cullen sign?

Cullen sign doesn’t happen right away. It can take up to 48 hours before bleeding in your belly causes it. You may have other symptoms of severe internal bleeding, like feeling faint.

How did Cullen sign get its name?

Cullen sign is named for gynecologist Dr. Thomas Cullen. He was the first healthcare provider to describe the symptom in connection with ruptured ectopic pregnancy.

What’s the difference between Cullen sign and Grey Turner sign?

Cullen sign and Grey Turner sign are bruising that acute pancreatitis may cause. The difference is that Cullen sign appears around your belly button. Grey Turner sign is bruising on the side of your body between your ribs and your hip (flank). Grey Turner sign may happen if you bleed in the back of your belly.