Meckel's diverticulum presenting as an umbilical granuloma in a 4-month-old Somali infant: a rare case report.

Introduction and importance: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete obliteration of the vitelline duct. Although usually asymptomatic, it may rarely present as an umbilical lesion resembling an umbilical granuloma, creating diagnostic challenges in low-resource settings. Presentation of case: A 4-month-old Somali male infant presented with a persistent umbilical mass and mucous discharge. The lesion had previously been diagnosed as an umbilical granuloma and treated with silver nitrate without improvement. Examination showed a red granulation-like mass at the umbilicus. During surgical exploration, the lesion was found to be a narrow-based Meckel's diverticulum connected to the ileum through a persistent vitelline duct. A wedge resection with end-to-end anastomosis was performed. The postoperative course was uneventful, and the infant remained well at 1-month follow-up. Clinical discussion: MD affects about 2% of the population and typically presents with bleeding, obstruction, or diverticulitis. Presentation as an umbilical lesion is extremely rare and occurs when the vitelline duct remains patent. Diagnosis often relies on imaging such as a Meckel scan, but none was done here due to presumed granuloma. Surgical resection is the treatment of choice when MD is identified intraoperatively. Conclusion: Persistent or atypical umbilical lesions that fail to respond to conservative treatment should raise suspicion for vitelline duct remnants, including MD. Early surgical evaluation is essential to avoid complications and ensure accurate diagnosis, particularly in resource-limited settings like Somalia.