| A 28-year-old man with "ulcer pain acting up again" |
| 来源:急救快车;添加日期:2002-8-3;编辑:artemis |
kulleni
A 28-year-old man presented to the emergency department with what he called his ulcer pain acting up again. The patient has a documented peptic ulcer and presents to the ED on occasion for exacerbation of pain. This episode of pain was again localized to the epigastric region, had started intermittently approximately two days earlier, and was not relieved with his antacids.
The physician performed a cursory exam, as the shift was quite busy. There was reproducible tenderness in the epigastric area, but no rigidity or rebound. A rectal examination was unremarkable. IM Meperidine (Demerol) was ordered after which time the patient felt moderately improved and asked to go home. As he stood to get dressed, a nurse standing nearby noticed the findings shown in the images below. The physician was summoned to the bedside.
Turners Sign in the setting of acute pancreatitis
Turners sign (sometimes referred to as Grey-Turners sign) is manifested by the ecchymotic discoloration of the flank and is classically associated with hemorrhagic pancreatitis. However, this sign develops in <3% of patients with acute pancreatitis and has also been reported to occur with retroperitoneal hemorrhage, splenic rupture, ruptured aortic aneurysm, and ectopic pregnancy. In fact, any process causing hemoperitoneum may lead to diffusion of blood along fascial planes and cause ecchymoses over the flanks. At least one report described the development of Turners sign associated with extensive liver metastases and hemorrhage into the hepatic lesions, without any evidence of hemoperitoneum.
Recent anatomical and radiological studies have concluded that Turners sign is produced by the spread of hemorrhagic fluid from the posterior pararenal space to the lateral edge of the quadratus lumbrum muscle and, subsequently, to the subcutaneous tissues via a defect in the fascia of the flank.
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