Lipomatous Hyperplasia of the Ileocecal Valve

Kathleen S Lee, MD
Madeleine D Kraus, MD
John Braver, MD

November 1, 1994

Presentation

Imaging Findings

Single contrast barium enema shows a solitary, smoothly marginated filling defect (arrows) in the ileocecal valve region. There are shelf-like sharp margins (arrows) but no apparent mucosal irregularity. Barium refluxed into a normal-appearing appendix and distal ileum.

Differential Diagnosis

Additional, although unlikely, considerations include inflammatory and infectious etiologies such as Crohn's enteritis, ulcerative colitis, or an ameboma. These entities should have associated mucosal abnormality, however.

Diagnosis

Discussion

Lipomatous hyperplasia of the ileocecal valve is benign focal proliferation of submucosal fat within the ileocecal valve. The disorder is usually an incidental finding on barium enema, as most patients are asymptomatic. Occasionally the abnormality causes vague abdominal pain. It is more common in females and in patients less than 40 years old. An abdominal CT scan can be helpful for diagnosis, showing an ileocecal valve mass of fat attenuation. Before the era of CT, water enemas were performed to evaluate these fatty abnormalites. The fatty lesions were lucent relative to the water-filled bowel.

Radiologic imaging often cannot distinguish lipoma and lipomatous hyperplasia of the ileocecal valve. Pathologically, a lipoma is focal accumulation of fat, whereas lipomatous hyperplasia is diffuse accumulation of fat in the ileocecal valve.

Pathologic Discussion

Lipohyperplasia of the ileocecal valve is an uncommon and benign cause of small bowel obstruction. Its etiology is unknown. No other tumors or tumor-like conditions are associated. Grossly, the bowel mucosa is intact but bulges due to submucosal infiltration by adipose tissue.

The differential diagnosis may include liposarcoma, which is extremely rare and can be excluded with thorough examination of carefully prepared slides for lipoblasts.

References

2. Margulis. Alimentary Tract Radiology. St. Louis: Mosby,1989;885.

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