Gastrointestinal tract lipomas

Last revised by Vikas Shah on 10 Oct 2023

Gastrointestinal tract lipomas are not uncommon and can be found anywhere along the entire length of the gastrointestinal tract

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Gastrointestinal tract lipomas are most frequently encountered between the ages of 50 and 70 years 3.

The majority of lipomas are asymptomatic and found incidentally. As they can be pedunculated (see below) they occasionally present as the leading point of an intussusception. When large they may develop mucosal ulceration and present with iron deficiency anemia or positive fecal occult blood testing 3. Acute heavy bleeding is uncommon.

Gastrointestinal lipomas, like lipomas elsewhere, are composed of mature adipocytes with an enveloping fibrous capsule 3.

The vast majority (90-95%) 2,3 are submucosal, with only a small number subserosal, and can be sessile or pedunculated 2

Lipomas are usually submucosal or occasionally pedunculated. They usually have a very smooth surface, unless mucosal ulceration is present. The squeeze sign, whereby the lipoma is seen to change in size and shape during peristalsis, is thought to be pathognomic for a colonic lipoma. 

On both CT and MRI lipomas are usually easy to diagnose on account of their density (-80 to -120 HU) / intensity following that of fat on all sequences. Lipomas are usually entirely of fat density without solid components. If a solid non-fat component is seen then the possibility of the mass representing a liposarcoma should be entertained, although these are exceedingly rare 1. Overlying ulceration may result in some non-fat density/intensity stranding near the mucosal surface.

As these are benign slow-growing lesions, and usually little doubt exists as to the diagnosis, no treatment is required. If symptomatic then local excision is sufficient 4.

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