SUBCUTANEOUS MANIFESTATIONS OF SEVERE ACUTE-PANCREATITIS

Subcutaneous manifestations of severe acute pancreatitis (Grey Turner' s sign, Cullen's sign, and disseminated fat necrosis) are often discus sed but seldom observed. Grey Turner's sign and Cullen's sign develop in <3% of patients with acute pancreatitis; subcutaneous fat necrosis occurs even less frequently. Few younger physicians have ever seen rep resentative cases. Only recently have studies begun to clarify the dev elopment of these clinical signs. Grey Turner's sign is produced by th e spread of hemorrhagic fluid from the posterior pararenal space to th e lateral edge of the quadratus lumborum muscle and, subsequently, to the subcutaneous tissues via a defect in the fascia of the flank. Cull en's sign arises from the diffusion of retroperitoneal blood into the falciform ligament and, subsequently, to the subcutaneous umbilical ti ssues via the connective tissue covering of the round ligament complex . In contrast to the ecchymotic signs, our review of the existing Lite rature concerning the development of subcutaneous fat necrosis in pati ents with acute pancreatitis did not reveal a definitive pathogenesis. Multiple factors seem to be involved in the production of subcutaneou s fat necrosis, and a simple cause-and-effect relationship of circulat ing lipolytic enzymes seems unlikely.