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Images of Memorable Cases: Case 21

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

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Case_21-pres1-1.jpg

This 40-year-old woman complained of worsening epigastric pain of five days’ duration. On examination, she had hypotension, a board-like abdomen, and extensive ecchymoses over her right loin.

21. Hemorrhagic pancreatitis

Emergency celiotomy disclosed a boggy pancreas, fat necrosis of the omentum, and reddish-brown peritoneal fluid. The ecchymotic discoloration of her loin—Turner’s sign—is not specific for pancreatitis. In the absence of trauma or blood disorders, it is a manifestation of retroperitoneal or intraabdominal hemorrhage.

The image shown displays another indication of retroperitoneal hemorrhage—ecchymotic patches on the anterolateral surface of one or both thighs just below the inguinal ligament (Fox’s sign). The discoloration (arrows) presumably results from bloody fluid tracking extraperitoneally along the fascia of the psoas and iliacus muscles, becoming subcutaneous in the upper thigh.

Case_21-diag1-1.jpg

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