Demarcated Truncal Jaundice: A Sign of Retroperitoneal Bile Leakage

Authors

Vivian C. McAlister, The University of Western Ontario
Alp Sener, The University of Western Ontario

Document Type

Article

Publication Date

3-1-2005

Journal

Annals of Internal Medicine

Volume

142

Issue

5

First Page

389

Last Page

389

Abstract

The characteristic feature of the clinical sign described here is the demarcation between jaundiced and unaffected areas of the body. The flanks and the genitalia are stained more than would be expected by examination of the sclera or estimation of bilirubin level. Superiorly, a horizontal line about 3 cm below the clavicles, corresponding to the insertion of the fascia of Scarpa into the clavipectoral fascia, allows an easy comparison between the jaundiced trunk and unaffected adjacent areas, such as the neck, shoulder, and arm. Similarly, a line 3 cm below the groin skin crease corresponds to the insertion of the fascia of Scarpa into the fascia lata of the thigh. In former times, such a sign might have been called icterus marginatus.