Images in Clinical Medicine
Bryant's and Stabler's Signs after a Difficult Delivery
N Engl J Med 2011; 365:1824November 10, 2011
- Article
A neonate presented after birth with scrotal and right inguinal ecchymosis. He had been born at term after a difficult vaginal delivery that ultimately required both fundal pressure and vacuum extraction. The thorax was not manipulated during birth. Despite the challenging delivery, the physical examination at birth was normal. A few hours later, however, the child appeared to be in discomfort, with moaning, and was newly noted to have cyanosis. Reexamination revealed ecchymosis of the scrotum and right inguinal region (Panel A). Laboratory results showed a decrease in the hematocrit from 41.2% at birth to 32.5%, normal measures of blood coagulation, and slightly elevated liver enzymes. Ultrasonography revealed three subcapsular lacerations of the liver (in the quadrate lobe and in segments 5 through 7). This case demonstrates an example of Bryant's sign (scrotal ecchymosis) and Stabler's sign (inguinal ecchymosis) caused by retroperitoneal hemorrhage. In this case, the retroperitoneal bleeding was caused by a perinatal liver laceration. The infant required no specific intervention and was discharged home after 1 week, with improvement of the inguinal ecchymosis (Panel B). Follow-up after 1 month revealed no remaining ecchymosis (Panel C).
Stijn R.G. Heyman, M.D.
Dirk Vervloessem, M.D.
ZNA Queen Paola Children's Hospital, Antwerp, Belgium
dirk.vervloessem@zna. be
