Lipomatosis of the ileocecal valve

Lipomatosis of the ileocecal valve is a benign condition usually detected incidentally during investigation of other conditions. However, it may itself cause certain vague abdominal symptoms and may be missed on preliminary ultrasound unless a high level of suspicion is present.

Epidemiology

This condition is usually seen in adults older than 40 years and more prevalent in females.

Clinical presentation

Non-specific symptoms are present:

• vague abdominal discomfort
• constipation
• cramping
• vomiting and nausea
• chronic right iliac fossa pain

Pathology

Lipomatosis of the ileocecal valve is characterized by increased fatty infiltration in the submucosal layer. The symptoms are produced in part by recurrent intussusception and bowel obstruction.

Radiographic features

Fluoroscopy: barium studies

May show a smooth mass like enlargement of the ileocecal valve. The lips of the ileocecal valve are thickened and show nodularity; however, the margins are smooth.

Ultrasound

The ileocecal valve will appear bulky and hyperechoic on ultrasound. Associated intussusception may be identified if present.

CT

CT establishes this entity beyond doubt. Circumferential thickening of lips of the ileocecal valve is seen showing fat attenuation.

MRI

MRI is seldom required for diagnosis. However, the lesion shows circumferential thickening with high signal appearance of the ileocecal valve on both T1 and T2 weighted images and shows loss of signal on fat suppressed sequence.

Treatment and prognosis

No definite management is required if asymptomatic.

Surgical resection is done when complications like intussusception and bowel obstruction are present.

Surgical resection is also done in cases of atypical appearance to rule out malignant lesion.

Differential diagnosis

Imaging differential considerations include:

• true lipoma of ileocecal valve