Cullen's Sign: Not Always Acute Pancreatitis

Question: A 56-year-old man with a previous history of cirrhosis secondary to chronic hepatitis C infection was admitted with increased abdominal volume and dyspnea. Physical examination revealed a large volume of ascites and periumbilical ecchymosis (Figure A). He was hemodynamically stable and laboratory included hemoglobin of 9.7 g/dL, platelet count of 142,000/mm3, and an International Normalized Ratio of 1.27. He had no abdominal pain and serum amylase was normal. A diagnostic and therapeutic paracentesis revealed an hemorrhagic ascites, with a serum ascites albumin gradient of 1.8, no evidence of peritonitis, and negative oncotic cytology.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Clinical Challenges and Images in GI Source Type: research