Overview of Karen’s Sign

Karen’s sign is the term used to describe the discoloration around the belly button. It appears as swelling, bruising, and an unusual color in fatty tissue. People with certain health conditions may develop Karen’s sign, such as:

  • pancreatitisPancreatic inflammation
  • ectopic pregnancy
  • liver problems
  • Thyroid cancer
  • Other sources of intra-abdominal bleeding

This condition often coexists with Gretner’s sign. Gray Turner’s signs are bruising on the abdominal wall or side.

Karen’s sign is relatively rare. It is seen in less than 1% of ectopic pregnancies and 1-3% of patients with pancreatitis. When it does, it is considered a sign of serious health problems.

This article looks at the symptoms, causes, and diagnosis of Karen’s sign. It also reviews some treatments for conditions associated with this symptom.

Karen’s Signs Symptoms

Cullen’s sign is characterized by severe discoloration, bruising, and swelling around the navel. The color of the bruise varies depending on the severity. In moderate cases it may be yellow or green, and in severe cases it may be purple.

Some but not all patients experience pain and discomfort in this area.

Causes of Karen’s Sign

Karen’s sign occurs when blood and/or pancreatic enzymes collect in the tissue beneath the skin. A range of conditions can cause this, including:

acute pancreatitis

The pancreas is an organ that produces digestive enzymes and hormones. Pancreatitis is a condition in which the pancreas becomes inflamed.

Pancreatitis occurs when digestive enzymes become active before they are released into the small intestine. These enzymes can damage the pancreas, which can lead to pain, internal bleeding, and cysts. Acute cases develop rapidly and can even be fatal if left untreated.

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In cases of acute pancreatitis, Cullen’s sign tends to appear 24 to 72 hours after the onset of the disease.

Pancreatic/abdominal trauma

An accidental injury to the pancreas or abdomen can cause internal bleeding. This can also lead to Karen’s sign.


Cullen’s sign is often associated with pancreatic conditions. This includes acute pancreatitis and pancreatic injury.

Ectopic pregnancy

Ectopic pregnancy occurs when a fertilized egg attaches to a location outside the uterus. Most occur in the fallopian tubes. These pregnancies are infeasible, which means they cannot be completed. If left untreated, they can cause dangerous internal bleeding.


Cullen’s sign can indicate an ectopic pregnancy. This is a dangerous situation where a fertilized egg attaches to a location other than inside the uterus.

ruptured abdominal aorta

The abdominal aorta is the main artery that carries blood from the heart to the abdomen. When it breaks, it can cause severe pain in the area as well as lower back pain. It can also cause Karen’s sign.

spleen rupture

The spleen is an organ located under the left rib cage. A ruptured spleen causes blood to build up in the abdomen and is considered a medical emergency.

ovarian cyst

Ovarian cysts are fluid-filled sacs in the ovaries. In most cases, this very common condition has no symptoms. But sometimes, cysts can grow so large that they need to be removed. When this happens, Karen’s sign may occur.


Ruptured abdominal aorta and ruptured spleen are two conditions that can cause blood to build up in the abdomen. Ovarian cysts can also cause Karen’s sign when they become larger.

Thyroid cancer

The thyroid is a butterfly-shaped gland in the throat. Cullen’s sign can be one of many symptoms of cancer in this gland. However, in many cases, thyroid cancer has no symptoms.

Esophageal cancer

esophagus Cancer is cancer in the tube that connects the throat and stomach. Karen’s sign occurs when cancer begins to metastasize or spread throughout the body. The prognosis for these cases is very poor.

non-Hodgkin lymphoma

Non-Hodgkin lymphoma occurs when cancer begins to develop in white blood cells. This can cause a range of symptoms, including swollen lymph nodes in the throat. It can also damage the spleen, which can lead to Karen’s sign.


Certain types of cancer, such as thyroid cancer, esophageal cancer, and non-Hodgkin’s lymphoma, are associated with Cullen’s sign.

percutaneous liver biopsy

The test involves taking a tissue sample from the liver using a special needle. It is usually done when doctors suspect cancer. In rare cases, the test can cause excessive bleeding, leading to Cullen’s sign.

Amoebic liver abscess

Entamoeba histolytica is an amoeba that can infect liver tissue, causing pus to build up. The infection is more common in areas with poor sanitation and crowded areas. It can lead to a range of health problems and may manifest as Karen’s sign.


Karen’s sign may also indicate certain liver problems, such as bleeding after a biopsy or an amebic infection.

strangulated umbilical hernia

The umbilical cord connects the mother and fetus during pregnancy. The umbilical cord is cut after birth and healed to form the belly button. However, in about 20% of cases, it may take longer to heal or not heal at all. Abdominal bleeding can cause Karen’s sign.

Karen’s sign is sometimes seen in babies when the navel heals slowly after birth.


When doctors see Karen’s sign, it indicates that they need to diagnose the underlying cause.

Cullen’s sign usually indicates a serious condition. For example, studies have found that as many as 37 percent of pancreatitis cases with this marker are ultimately fatal.


Treating Cullen’s sign means treating the disorder or disease that causes it. For example, pancreatitis can be treated by:

  • targeted fasting
  • Rehydration via IV
  • painkiller
  • Pancreatic or gallbladder surgery

Ectopic pregnancy can be treated with drugs that stop cell growth, Laparoscopy surgery or other medical procedures. Cancer requires surgery, chemotherapy or radiation therapy.


Because Cullen’s sign points to a more serious underlying disorder, its diagnosis and treatment depend on identifying the underlying cause.


Karen’s sign is discoloration and swelling around the belly button. It usually occurs when there is a serious underlying medical condition.

Pancreatitis, ectopic pregnancy, and certain cancers are some of the conditions associated with Cullen’s sign.

Diagnosis and treatment includes diagnosing and treating the underlying cause.

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What’s worrying about the Karen logo is what it might point to. Many of the underlying problems are serious and require immediate medical attention.

If you see signs of this condition, talk to your doctor right away. The sooner doctors can find the cause, the better. Ask for help anytime. Getting the right care in a timely manner can sometimes mean the difference between life and death.