article · International Journal of Surgery Case Reports
Meckel diverticulum is a common congenital anomaly of the digestive tract, but complications arise in only a small percentage of cases and are rarely documented in adults. A 21-year-old male presented with persistent periumbilical pain, low-grade fever, purulent discharge from the navel, and granulomatous tissue. Standard laboratory tests were normal, while an ultrasound scan suggested an infected urachal remnant. Surgical exploration identified an inflamed Meckel diverticulum joined to the umbilicus by a fibrous band, rather than a urachal issue. The patient underwent surgical removal of the diverticulum, excision of the connecting tract and granuloma, and umbilical reconstruction. Histopathology demonstrated chronic inflammation without ectopic tissue, and the patient recovered without incident. The report highlights that surgical exploration provides both an accurate diagnosis and effective management when unusual umbilical symptoms arise.
Persistent umbilical discharge in adults can stem from unusual developmental anomalies that mimic other disorders. Recognising that Meckel diverticulum can cause these symptoms helps clinicians make accurate differential diagnoses. Prompt surgical exploration allows teams to identify the true underlying source and provide curative treatment, which is particularly crucial in healthcare settings with limited advanced diagnostic tools.
The abstract does not indicate an application pathway, as it describes a single clinical case report and standard surgical intervention.
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BACKGROUND: Meckel's diverticulum (MD), a congenital anomaly of the gastrointestinal tract, affects approximately 2 % of the population, but complications occur in only 4-6 % of cases. Symptomatic MD is typically seen in children, with adult presentations being rare and often incidental. Umbilical complications related to persistent vitelline duct remnants are extremely uncommon in adults. CASE PRESENTATION: A 21-year-old-male without previous abdominal symptoms presented with a two-year history of dull periumbilical pain, gradually progressing to purulent umbilical discharge, low-grade fever, a small sinus opening, and granulomatous tissue. Laboratory investigations including CBC, CRP, and liver/renal panels were normal. Ultrasound revealed a hypoechoic tract from the umbilicus to the pelvis, suggestive of an infected urachal remnant. Exploratory laparotomy revealed a 2-inch inflamed Meckel's diverticulum located 65 cm from the ileocecal valve, connected to the umbilicus by a fibrous tract. Diverticulectomy, excision of the tract and granuloma, and umbilicoplasty were performed. Histopathology confirmed MD with chronic inflammation and no ectopic mucosa. The postoperative course was uneventful. DISCUSSION: This case illustrates a rare adult complication of MD presenting as an umbilical sinus with granulomatous changes, mimicking a urachal anomaly. While adult MD typically presents with bleeding, obstruction, or inflammation, umbilical fistulation is rarely reported in adults. Early surgical exploration was essential for accurate diagnosis and treatment. CONCLUSION: Infected MD with umbilical perforation and granulomatous tissue is exceptionally rare in adults. It should be considered in the differential diagnosis of persistent umbilical discharge. Surgical exploration can provide definitive diagnosis and curative treatment, particularly in resource-limited settings.
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DOI: 10.1016/j.ijscr.2025.111841
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