An Overview of Cullen Sign

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Cullen sign is a term used to describe a discoloration around the navel. It appears in the fatty tissue as swelling, bruising, and an unusual color. Cullen sign may be seen in patients with certain health conditions, such as:

This condition often coexists with Grey Turner’s sign. Grey Turner's sign appears as a bruising of the abdominal walls or flanks.

Cullen sign is relatively rare. It’s seen in less than 1% of ectopic pregnancies, and in 1-3% of pancreatitis patients. When it does appear, it's considered a marker of serious health problems.

This article looks at the symptoms, causes, and diagnosis of Cullen sign. It also reviews some of the ways the diseases associated with this symptom are treated.

Verywell / Madelyn Goodnight

Cullen Sign Symptoms

Cullen sign appears as severe discoloration, bruising, and swelling around the navel. The color of the bruise varies based on severity. In moderate cases, it may be yellow or green, and in severe cases, it may be purple.

Some but not all patients feel pain and discomfort in the area.

Causes of Cullen Sign

Cullen sign happens when blood and/or pancreatic enzymes pool in tissues just beneath the skin. A range of conditions might cause this, including:

Acute Pancreatitis

The pancreas is an organ that produces digestive enzymes and hormones. Pancreatitis is a condition where the pancreas becomes inflamed.

Pancreatitis happens when digestive enzymes become active before they are released into the small intestine. These enzymes damage the pancreas, which can cause pain, internal bleeding, and cysts. Acute cases form quickly and can even be fatal if left untreated.

In cases of acute pancreatitis, Cullen sign tends to show up 24 to 72 hours after onset of the condition.

Pancreatic/Abdominal Trauma

Injury to the pancreas or abdominal region due to an accident can cause internal bleeding. This can also lead to Cullen sign.

Recap

Cullen sign is often linked to conditions of the pancreas. This includes acute pancreatitis and injuries to the pancreas.

Ectopic Pregnancy

An ectopic pregnancy happens when a fertilized egg attaches to a location outside the uterus. Most happen in the fallopian tubes. These pregnancies aren't viable, meaning they can't come to term. If left untreated, they can cause dangerous internal bleeding.

Recap

Cullen sign can point to an ectopic pregnancy. This is a dangerous condition where a fertilized egg attaches to a location other than inside the uterus.

Ruptured Abdominal Aorta

The abdominal aorta is a major artery that moves blood from the heart to the abdomen. When it ruptures, it can cause severe pain in the area as well as low back pain. It can also lead to Cullen sign.

Ruptured Spleen

The spleen is an organ located under the left rib cage. A rupture of the spleen causes blood to pool in the abdomen and is considered a medical emergency.

Ovarian Cysts

Ovarian cysts are fluid-filled sacs in the ovaries. In most cases, this very common condition does not have symptoms. Sometimes, though, a cyst can grow so large it needs to be removed. When this happens, Cullen sign may appear.

Recap

A ruptured abdominal aorta and a ruptured spleen are two conditions that can cause blood to pool in the abdomen. Ovarian cysts may also cause Cullen sign when they become large.

Thyroid Cancer

The thyroid is a butterfly-shaped gland in the throat. Cullen sign can be one of many symptoms of cancer in this gland. In many cases, however, thyroid cancer has no symptoms.

Esophageal Cancer

Esophageal cancer is a cancer in the tube that connects the throat to the stomach. Cullen sign can appear when the cancer starts to metastasize, or spread throughout the body. The prognosis in these cases is very poor. 

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma happens when cancer starts to develop in white blood cells. This can cause a range of symptoms including swelling of the lymph nodes in the throat. It can also damage the spleen, which can lead to Cullen sign.

Recap

Certain kinds of cancer like cancer of the thyroid, cancer of the esophagus, and non-Hodgkin lymphoma are associated with Cullen sign.

Percutaneous Liver Biopsy

This test involves extracting a tissue sample from the liver using a special kind of needle. It is usually done when doctors suspect cancer. In rare cases, this test can cause excessive bleeding that leads to Cullen sign.

Amoebic Liver Abscess

Entamoeba histolytica is an amoeba that can infect the tissues of the liver, causing a buildup of pus. This kind of infection is more common in areas with poor sanitation and crowded conditions. It can lead to a range of health problems and can appear as Cullen sign.

Recap

Cullen sign may also point to certain liver problems, such as bleeding after a biopsy or an amoebic infection.

Strangulated Umbilical Hernia

The umbilical cord connects mother and fetus during pregnancy. The cord is cut after birth and heals up to form the belly button. In around 20% of cases, though, it can take much longer to heal or not heal at all. The bleeding that happens in the abdominal area can lead to Cullen sign.

Cullen sign is sometimes seen in babies when the belly button is slow to heal after birth.

Diagnosis

When doctors see Cullen sign, it indicates they need to diagnose the underlying cause.

Cullen sign often points to a serious condition. For example, studies have found that up to 37% of pancreatitis cases that have this marker end up being fatal.

Treatment

Treating Cullen sign means treating the disorder or disease that's causing it. Pancreatitis, for example, can be treated with:

  • Directed fasting
  • Fluid replacement via IV
  • Medication for pain
  • Surgery of the pancreas or gallbladder

Ectopic pregnancy can be treated with drugs that prevent cell growth, laparoscopic surgery, or other medical procedures. Cancers require surgery, chemotherapy, or radiation treatment. 

Recap

Because Cullen sign points to a more serious underlying condition, both its diagnosis and treatment depend on identifying the underlying cause.

Summary

Cullen sign is a discoloration and swelling around the belly button. It usually appears when there is a serious underlying medical condition.

Pancreatitis, ectopic pregnancy, and certain cancers are a few of the conditions associated with Cullen sign.

Diagnosis and treatment involve diagnosing and treating the underlying cause.

A Word From Verywell

What’s alarming about Cullen sign is what it might point to. Many of the underlying issues are severe and require immediate medical attention.

If you’re seeing signs of this condition, talk to your doctor at once. The sooner your doctor can find the cause, the better. Always feel free to ask for help. Getting the right care in a timely manner can sometimes mean the difference between life and death.

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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