Clinics and Research in Hepatology and Gastroenterology (2013) 37, 3—5

Available online at

www.sciencedirect.com

IMAGE OF THE MONTH

Lipomatosis of the small intestine

Yen-Lin Chen a,b, Tien-Yu Huang c, Wei-Chou Chang a,∗
a
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325, Cheng-Kung Road, Sec. 2,
Taipei, 114, Taiwan, PR China
b
Department of Radiology, Armed-Forces Taoyuan General Hospital, Taoyuan, Taiwan, PR China
c
Division of gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center,
Taiwan, PR China

Available online 1 May 2012

A 43-year-old presented for evaluation of incidentally find-
ings in the terminal ileum on previous barium enema.
His past history was unremarkable. Physical examination
and routine laboratory studies did not document signifi-
cant findings. Gastrointestinal series was carried out and
demonstrated multiple smooth-walled radiolucent masses
projected into lumen of jejunum and upper ileum (Fig. 1A).
Computed tomography (CT) of the abdomen performed
with intravenous and oral contrast material revealed fat
density tumors in distal jejunum and ileum (Fig. 2B). Single-
balloon enteroscopy showed multiple yellowish polypoid
lesions of various sizes with cushion sign in distal ileum (Fig.
2A). Unroofing polypectomy was done at one bigger polyp
(Fig. 2B). Examination of the specimen showed lobules of
mature adipose tissue that were consistent with lipomatosis.
Since the patient was asymptomatic, he received no treat-
ment. At 1-year follow-up visit, the patient has remained
symptom-free.

∗ Corresponding author. Tel.: +886 2 8792 7244;

fax: +886 2 8792 7245.

E-mail address: weichou.chang@gmail.com (W.-C. Chang).

2210-7401/$ – see front matter © 2012 Published by Elsevier Masson SAS.

doi:10.1016/j.clinre.2012.03.011
4 Y.-L. Chen et al.

Figure 1 A. Gastrointestinal series demonstrated multi-

ple smooth-walled radiolucent masses projected into lumen
of jejunum and upper ileum (arrows). B. Computed tomog-
raphy (CT) of the abdomen with coronal reconstruction
revealed fat density tumors in distal jejunum and ileum
(arrows).

Figure 2 A. Single-balloon enteroscopy showed multi-

ple yellowish polypoid lesions of various sizes in distal
ileum. B. Unroofing polypectomy was done at one bigger
intestine. With aid of CT, intestinal lipomatosis is distin-
polyp.
guished from liposarcoma by the homogeneity of its fatty
Small intestinal lipomatosis is a rare clinicopathological
content and absence of areas of increased density [2]. The
entity characterized by diffuse infiltration and overgrowth
differential diagnosis of intestinal lipomatosis includes the
of well-differentiated adipose tissue on submucosal layer
multiple polyposis syndromes, lymphoma, neurofibromas,
of small intestine. Pathologically, proliferation of adipose
mesenteric masses, and metastases, but the characteris-
cells could be confined to the submucosal layer or may
tic appearance of fatty masses on CT, barium study, and
extend to the serosal layer or mesenteric fat [1]. This
endoscopy of the small intestine can be highly convincing
condition may be asymptomatic, and probably needs no
of the diagnosis.
treatment. However, symptomatic cases may present as
intestinal obstruction, intussusception, volvulus, or bleeding
by mucosal ulceration, and require surgical resection of the
affected bowel. CT scan is the imaging modality of choice
when lipomatosis of small intestine is suspected clinically. It Disclosure of interest
is useful both in making the diagnosis by confirming the fatty
nature of these benign tumors, and in assessing the rela- The authors declare that they have no conflicts of interest
tionship of various surrounding structures with the involved concerning this article.
Lipomatosis of the small intestine 5

References [2] Waligore MP, Stephens DH, Soule EH, McLeod RA. Lipomatous
tumors of the abdominal cavity: CT appearance and pathologic
corrfelation. AJR 1981;137:539—45.
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Salazar Lozano CR, Martinez Gen R. Multiple intestinal lipomato-
sis. Case report. Cir Cir 2010;78:163—5.