Unusual presentation of an infected Meckel's diverticulum with umbilical perforation and granulomatous lesion in a young Adult: A rare case report from a resource-constrained setting

Abstract

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.

Keywords: Case report; Diverticulectomy; Granulomatous lesion; Meckel's diverticulum; Umbilical perforation; Vitelline duct remnant.

Fig. 1

Clinical image showing an umbilical sinus opening (blue arrow) accompanied by surrounding erythema, scant purulent discharge, and a central granulomatous tissue mass (black arrow), suggestive of localized infection, chronic inflammation, and persistent epithelialized tract requiring further evaluation and potential surgical intervention.

Fig. 2

Illustration demonstrating an umbilicus with a sinus discharging pus-like fluid (black arrow), and a laparotomy approach performed through an infraumbilical midline incision (blue arrow), indicating the surgical pathway used for exploration and definitive management of the underlying pathology.

Fig. 3

Intraoperative findings show a tubular structure with luminal contents (black arrow), representing an inflamed tract extending from the umbilicus to the ileum, consistent with a persistent vitelline duct remnant causing chronic infection and discharge.

Fig. 4

Intraoperative view showing the diverticulum detached from its bowel wall base (black arrows), with dense adhesions to the umbilicus (yellow arrow) and significant wall thickening, consistent with chronic inflammation and suggesting a persistent vitelline duct remnant requiring surgical excision.

Fig. 5

A and B: Image A shows the completely excised diverticulum, while Image B demonstrates a two-layer ileal closure (black arrow) performed using 3-0 Vicryl sutures, ensuring secure primary repair and restoration of bowel continuity following diverticulum resection.

Fig. 6

A and B: Image A shows the initial infraumbilical midline incision approach, while Image B illustrates the extended incision made to facilitate en bloc excision of umbilical granulomatous tissue and layered umbilical reconstruction, ensuring complete removal and optimal cosmetic and structural restoration of the umbilicus.