So-called skin signs in acute pancreatitis

Skin signs in acute necrotizing pancreatitis (e. g., Cullen's and Grey-Turner's sign) have been described in clinical medicine. The aim of the present study was to evaluate if, and how often, skin signs were noted in autopsy-confirmed cases of necrotizing pancreatitis. In a first step, the literature was extensively reviewed to establish which skin signs have so far been described in acute pancreatitis cases. As a second step, the reports of 16,000 autopsies performed at the Institutes of Legal Medicine in Frankfurt am Main and Giessen, Germany, were retrospectively evaluated. Twenty cases with necrotizing pancreatitis were found. In almost all of these, necrotizing pancreatitis was - either solely or in combination with other factors - the cause of death. In three cases, discolorations of the skin were found that were considered to be skin signs due to their location. At least in the evaluated medicolegal autopsy pool, skin signs in necrotizing pancreatitis thus appear to be a rare occurrence. Nevertheless, in cases of unexpected death, particularly of individuals with a history of alcohol abuse, necrotizing pancreatitis should be considered in the differential diagnosis of hematomas possibly attributed to trauma.