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      Prolapsed Umbilical Meckel's Diverticulum Mimicking Umbilical Granuloma: A Rare Differential of a Common Problem

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          Abstract

          Umbilical lesions in children represent a wide spectrum of congenital or acquired anomalies. Congenital anomalies are mainly because of failed obliteration of the omphalomesenteric duct while acquired pathologies are either because of delayed umbilical cord separation causing umbilical granuloma or result from umbilical stump infection producing omphalitis with persistent discharge. Meckel's diverticulum is considered the most common gastrointestinal congenital anomaly resulting from obliteration failure of the omphalomesenteric duct while umbilical granuloma is a common acquired umbilical lesion seen in daily practice. Prolapsed Meckel's diverticulum mimicking an umbilical granuloma is rare; we report a case where it was misdiagnosed and mistreated as an umbilical granuloma based on its appearance.

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          Meckel’s diverticulum mimicking acute appendicitis in children: a retrospective cohort study

          Ling Yan, Bi Zhou, Peng Wu … (2024)
          Background The aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children. Materials and methods We retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel’s diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded. Results A total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1–13 years). Perforated Meckel’s diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix. Conclusions The most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.
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            Ileal prolapse through a patent vitellointestinal

            AK Gvalani, GV Acharya, RV Rao … (1985)
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              Umbilical Granuloma: Frequency, Associated Factors, 10-Year Treatment Trends, and Effectiveness at a Single Hospital in Japan.

              Shigeo Iijima (2023)
              Umbilical granuloma (UG) is a common problem during the neonatal period; however, its epidemiology and etiology are poorly studied, and the best treatment option has not yet been established. We examined the medical records of neonates who were born and underwent 1-month evaluations at our hospital between 2013 and 2022 to investigate the frequency of-and factors associated with-UG, as well as the annual trends of UG treatments and their efficacy. Of the 6680 eligible neonates, 395 (5.9%) had UG. The annual incidence rate ranged from 3.8% to 7.3%. Gestational age, birth weight, and incidence of meconium-stained amniotic fluid were significantly associated with UG. Silver nitrate cauterization was the predominant UG treatment from 2013 to 2016. Silver nitrate cauterization and topical betamethasone valerate were nearly equally applied in 2017. Betamethasone application became predominant in 2018. The healing rates during the initial treatment period were 91% for silver nitrate cauterization, 97.7% for betamethasone application, 60% for ethanol disinfection, and 88% for ligation; these rates were significantly different (p < 0.001). Topical steroid application may be the most effective treatment. If steroid application is ineffective, then silver nitrate cauterization and ligation may be important treatment options.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 24 December 2024
                Publication date (Electronic, collection): December 2024
                Volume: 16
                Issue: 12
                Electronic Location Identifier: e76351
                Affiliations
                [1 ] Pediatric Surgery, Combined Military Hospital Lahore, Lahore, PAK
                [2 ] Anaesthesiology, Combined Military Hospital Lahore, Lahore, PAK
                [3 ] Medicine, Lahore Medical and Dental College, Lahore, PAK
                [4 ] General Surgery, Combined Military Hospital Lahore, Lahore, PAK
                Author notes
                Article
                DOI: 10.7759/cureus.76351
                PMC ID: 11758586
                SO-VID: 4b144909-ff4c-4c5e-bea0-54e259a1797e
                Copyright © Copyright © 2024, Saleem et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 24 December 2024
                Categories
                Subject: Pediatric Surgery

                Keywords: gastrointestinal congenital anomaly,ileal prolapse,meckel´s diverticulum,omphalomesenteric duct,umbilical lesion
                Data availability:
                Keywords: gastrointestinal congenital anomaly, ileal prolapse, meckel´s diverticulum, omphalomesenteric duct, umbilical lesion

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