Grey Turner sign

In an article published in 1920, British surgeon George Grey Turner, MBBS (1877-1951), described subcutaneous discoloration of the flanks in patients with severe pancreatitis. About a patient with severe pancreatitis he wrote: "I now noticed two large discolored areas in the loins. They were about the size of the palm, slightly raised, and of a dirty greenish color. There was a little edema with dimpling on pressure, but there was no pain or tenderness. Since this publication, the investigative finding of ecchymosis on the flank associated with intra-abdominal hemorrhage has borne Dr. Turner's name.

Rare clinical sign in severe acute pancreatitis. It is caused by ecchymosis of the subcutaneous tissue due to the spreading enzyme-rich pancreatic exudate.

Classically, the changes correlate with severe acute necrotizing pancreatitis, often in association with Cullen's sign (periumbilical ecchymosis). The phenomenon may also occur in other conditions that result in intra-abdominal or retroperitoneal hemorrhage. The discoloration may also be green, yellow, or purple, depending on the breakdown of hemoglobin.

1. Chauhan S et al (2008) Cullen's and Turner's sign associated with portal hypertension. Lancet 372:54.
2. Mookadam F et al (2005) Images in clinical medicine. Cullen's and Turner's signs. N Engl J Med 353:1386.