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Grey-Turner Sign: Causes, Symptoms and Treatment

The Grey-Turner sign is a clinical indicator of severe internal bleeding: a grey-blue discolouration of the flanks, typically associated with acute pancreatitis or retroperitoneal haemorrhage.

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Things worth knowing about "Grey-Turner Sign"

The Grey-Turner sign is a clinical indicator of severe internal bleeding: a grey-blue discolouration of the flanks, typically associated with acute pancreatitis or retroperitoneal haemorrhage.

What is the Grey-Turner Sign?

The Grey-Turner sign (also written as Gray-Turner sign) refers to a grey-blue, livid, or greenish-brown discolouration of the skin along the flanks -- the lateral sides of the abdomen. It is a clinical sign that indicates retroperitoneal haemorrhage, meaning bleeding behind the peritoneum (the membrane lining the abdominal cavity). The sign was named after British surgeon George Grey Turner, who first described it in the early 20th century.

Causes

The Grey-Turner sign develops when blood or blood-stained fluid tracks along fascial planes from the retroperitoneum to the skin of the flank region. Common causes include:

Acute necrotising pancreatitis: The most frequent cause. In severe inflammation of the pancreas, digestive enzymes are released and can damage surrounding blood vessels, leading to significant internal bleeding.
Ruptured aortic aneurysm: A tear in a dilated section of the aorta can cause a life-threatening retroperitoneal haemorrhage.
Abdominal trauma: Blunt force injuries to the abdomen, such as from accidents, may result in retroperitoneal bleeding.
Other causes: Coagulation disorders, post-procedural bleeding, or ruptured retroperitoneal tumours.

Symptoms and Clinical Presentation

The Grey-Turner sign typically does not appear immediately but develops 24 to 72 hours after the onset of the underlying condition. It presents as:

Grey-blue, livid, or greenish-brown discolouration of the flanks (lateral abdominal wall)
Possible extension to the lower back or lower abdomen
The discolouration itself is usually not tender, although the patient typically experiences severe abdominal pain from the underlying disease

The Grey-Turner sign is often accompanied by other signs of serious illness, including severe abdominal pain, nausea, vomiting, fever, and general weakness. A closely related sign is the Cullen sign, which describes a similar periumbilical discolouration around the navel and also indicates retroperitoneal or intraperitoneal bleeding.

Diagnosis

The Grey-Turner sign is a purely clinical sign identified through visual inspection of the abdomen. Its presence warrants immediate further diagnostic evaluation:

Blood tests: Full blood count, coagulation studies, pancreatic enzymes (lipase, amylase), and inflammatory markers (CRP, white blood cell count)
Imaging: Abdominal ultrasound as an initial step; contrast-enhanced CT of the abdomen is the gold standard for accurately identifying bleeding and organ damage
MRI: Used in selected cases for further clarification

Because the Grey-Turner sign indicates a potentially life-threatening situation, its appearance requires immediate hospital admission and treatment.

Treatment

Treatment depends on the underlying cause and must always be managed in a hospital setting, often in an intensive care unit (ICU):

Acute pancreatitis: Intensive monitoring, intravenous fluid resuscitation, pain management, nutritional support, and surgical intervention if complications arise
Ruptured aortic aneurysm: Emergency surgery or endovascular repair (a minimally invasive procedure via the blood vessels)
Traumatic haemorrhage: Emergency surgical management, blood transfusions, and coagulation support as needed

The presence of the Grey-Turner sign is generally associated with a severe clinical course and an increased mortality rate. Rapid diagnosis and prompt treatment are critical to improving patient outcomes.

When to Seek Medical Help

If a grey-blue discolouration of the flanks appears -- especially in combination with severe abdominal pain -- emergency medical services should be called immediately or the nearest emergency department visited without delay. The Grey-Turner sign is a warning indicator of a potentially life-threatening internal haemorrhage that requires urgent medical attention.

References

Turner, G.G. (1920): Local discoloration of the abdominal wall as a sign of acute pancreatitis. British Journal of Surgery, 7(28), 394-395.
Banks, P.A. et al. (2013): Classification of acute pancreatitis -- 2012: revision of the Atlanta classification and definitions by international consensus. Gut, 62(1), 102-111.
Vissers, R.J. & Abu-Laban, R.B. (1999): Cullen's and Grey Turner's signs in acute pancreatitis. New England Journal of Medicine, 341(10), 789.

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