Cutaneous signs of acute pancreatitis

An 86-year-old septic patient with acute pancreatitis showed dirty green-greyish discolorations on the periumbilical and pubic regions (a) and on the flanks and upper parts of the thighs (b) beside a heparin injection-related haematoma (marked *). Four weeks later the patient died of multiorgan failure. The discolorations are based on subcutaneous ecchymosis caused by liberated pancreatic enzymes or retroperitoneal bleeding. Cullen (periumbilical, a), Stabler (pubic area, a), Turner (flanks, b) and Fox (thighs, b) signs, named after their first describers, are observed in < 3% of patients with acute pancreatitis and are associated with a fulminant progress (mortality rate up to 37%).