Which sign is most classically associated with pancreatitis and may present as periumbilical ecchymosis?

• A. Grey Turner's sign
• B. Cullen sign
• C. Fox's sign
• D. Kehr's sign

Answer: (B)

Periumbilical ecchymosis points to Cullen sign. In acute pancreatitis, blood from retroperitoneal bleeding can track along structures to the umbilicus, producing bruising around the navel. This makes Cullen sign the classic presentation for pancreatitis in the periumbilical region. Grey Turner's sign is flank bruising from retroperitoneal bleeding, Fox's sign is inguinal bruising, and Kehr's sign is referred shoulder pain from diaphragmatic irritation—none of these describe the periumbilical presentation.