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Bryant’s sign as a manifestation of a retroperitoneal paraduodenal bleed and subsequent small bowel obstruction
  1. Amelia Leigh Davis1,
  2. Talia Shepherd2,3,
  3. Mike Cadogan4 and
  4. Jonathan Foo2,5
  1. 1 Surgical Acute Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2 Upper Gastrointestinal Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  3. 3 The University of Western Australia, Perth, Western Australia, Australia
  4. 4 Emergency Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  5. 5 Discipline of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
  1. Correspondence to Dr Amelia Leigh Davis; amelialeighdavis{at}


Bryant’s sign is defined as ecchymosis at the base of the penis and scrotum and is usually associated with a retroperitoneal bleed or ruptured aortic aneurysm. We report the case of a retroperitoneal paraduodenal bleed which presented with Bryant’s sign. Imaging confirmed a pancreaticoduodenal arcade microaneurysm and associated low-grade coeliac artery stenosis (Sutton-Kadir syndrome). Retroperitoneal bleeding can be life threatening and requires prompt diagnosis and management. However, diagnosis can be challenging due to the clinical variation in presentation. The rarity of presentation in this case caused significant uncertainty necessitating a multidisciplinary approach for diagnostic clarity and safe patient care.

  • GI bleeding
  • Stomach and duodenum
  • Gastrointestinal surgery

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  • Contributors All authors had substantial contributions to the conception or design of the work, analysis or interpretation of data for the work, critical revision for important intellectual content and gave their final approval of the version to be published and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Initial care of the patient was with MC in the emergency department, ongoing inpatient care was with TS and JF and ongoing outpatient care was with JF. The planning and acquisition of data and drafting of the work were done by ALD. Figure 3 was illustrated by JF and labels/figure were added by ALD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.