Small Bowel Lipoma

General Considerations

• Small bowel tumors are relatively rare, accounting for only 2% of all GI malignancies
• Most lipomas of the GI tract occur in the colon, the small bowel being the 2^nd most common site and accounting for about 25%
• Usually solitary but may be multiple
• Most small bowel lipomas are found in the ileum
• Most often submucosal and may be pedunculated

Clinical Findings

• If small, usually no symptoms
• When symptoms occur, they are non-specific and may include
• Abdominal pain
• Constipation
• Diarrhea
• Nausea and vomiting
• GI hemorrhage (may be occult), especially when over 2 cm
• Obstruction (in up to 30% of symptomatic patients)
• Lead point of intussusception

Imaging Findings

• Conventional radiographs will be normal except when there is obstruction of the bowel
• CT will show a low density mass in the wall of the small bowel
• Homogeneous mass with Hounsfield units between −80 and –120
• Upper GI series may show a submucosal mass with obtuse borders that may have barium collections in central ulcerations
• The Lipoma may be noted to change its shape on different views owing to its pliability

Differential Diagnosis

• Adenomas
• Carcinoid tumor
• Intestinal polyposis syndromes

Treatment

• If symptomatic, they may be surgically removed

Lipoma of Small Bowel. The white arrow points to sharply marginated filling defect in the distal small bowel. The mass measures -71 Hounsfield units, consistent with fat density.
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Imaging and Findings of Lipomas of the Gastrointestinal Tract. WM Thompson .AJR:184, April 2005