Pelvic lipomatosis is a recently reported, rare entity of uncertain clinical significance. Although it is usually an incidental finding from a gastrointestinal or genitourinary evaluation, various symptoms, usually urologic, have been ascribed to its presence. The authors recently encountered three patients with this condition, however, all of whom had complaints that caused them to seek general surgical consultation. the first patient presented with abdominal pain associated with a pelvic mass; the second developed lower extremity thrombophlebitis; and the third had bowel obstruction from colonic cancer obscured by the pelvic lipomatosis. As it becomes increasingly apparent that this process may be associated with conditions of importance to the general surgeon, an awareness of its presentation, resultant complications, and the possibility of associated disease processes is required. Thorough, systemic evluation of all these patients is necessary, and exploratory laparotomy may be indicated to establish complete diagnosis.