Demarcated Truncal Jaundice: A Sign of Retroperitoneal Bile Leakage

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.