Almost twenty years ago T. S. Cullen1 drew attention to bluish discoloration of the umbilicus as a sign of ruptured extrauterine pregnancy and even though this sign is shown by only a small percentage of the patients with tubal gestation nevertheless quite a large number of cases showing bluish discoloration of the umbilicus have been now observed and reported. Hence I would hesitate to increase the already large number of reports of such cases were it not that a patient whom I recently had under my care showed a Cullen sign which differed from the majority of the cases already reported in that the discoloration of the skin and subcutaneous tissue did not appear at or around the umbilicus or in a postoperative hernia but in a thin spot in the abdominal wall which had developed as the result of an operation for a ruptured appendix. A careful study of
Brady L. RUPTURED TUBAL PREGNANCY: A HELPFUL DIAGNOSTIC SIGN. JAMA. 1939;112(7):628–629. doi:10.1001/jama.1939.62800070002010a
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