The persistence of ductal communication between the intestine and the yolk sac beyond the embryonic stage may result in several anomalies of the vitelline duct. These anomalies include Meckel’s diverticulum, vitelline cysts, umbilical-intestinal fistulas, and omphalomesenteric bands [6].

Meckel’s diverticulum is the most common congenital anomaly in the gastrointestinal tract [1]. This occurs due to the persistence of the proximal part of the congenital vitello-intestinal duct, and most studies suggest an incidence of between 0.6% and 4% [7]. Although many anatomical variations exist and are often discovered incidentally during evaluations performed for other reasons, it is also the most common cause of lower gastrointestinal bleeding in the pediatric age group [7]. It is a true diverticulum that is typically located on the anti-mesenteric border and contains all three coats of the intestinal wall, with its separate blood supply from the vitelline artery [7].

The incidence is equal in males and females, but complications occur more frequently in males [2, 8,9,10,11]. It is usually an asymptomatic condition, and if patients develop symptoms, they usually present with painless rectal bleeding in the first 10 years of life, with an average age of 2.5 years. [3] Rectal bleeding is often described as currant jelly or the color of brick. Children typically present with the classic “currant jelly” color, whereas adults typically present with melena, and the bleeding usually resolves without intervention (2). Complications can occur in up to 6.4% of patients [1]. These are more common in the pediatric population and mainly involve bowel obstruction with or without intussusception, gastrointestinal hemorrhage, diverticulitis and inflammation, and Littre hernias (hernia involving the bowel segment bearing Meckel’s syndrome) [1, 11].

However, diverticulitis mimicking urinary tract infection in children has not been reported.

Diverticulitis mimicking peri umbilical cellulitis in children has been reported. One patient was diagnosed with diverticulitis with suppurative inflammatory fluid collection in the lumen, and the tip of Meckel’s diverticulum was adherent to the abdominal wall around the umbilicus because of inflammation [12].

Suprapubic pain in children can be diagnostically challenging, as it overlaps with many potential conditions [5, 13]. While a urinary tract infection is often the first thing we consider—especially when there are urinary symptoms—it’s important to remember that other issues can present in a similar way [1]. Gastrointestinal causes like appendicitis, constipation, or even Meckel’s diverticulitis, as in this case, can mimic a UTI [1, 5]. In girls, gynecological causes should also be considered, such as ovarian torsion or menstrual-related pain [13]. When a patient isn’t improving as expected, we need to keep an open mind and revisit the diagnosis. A broad differential and timely imaging can make all the difference in catching less obvious conditions early.

The diagnostic criteria for Meckel’s diverticulum include the classic rule of 2s, characterized by the following: 2 inches in length, May present before the age of 2, Male-to-female ratio approximately 2:1,2 feet away from the ileocecal valve, occurring in 2% of the population, and containing 2 types of heterotopic mucosa (gastric and pancreatic) [1] anemia or gastrointestinal bleeding are the most frequent clinical manifestations and are found in up to 80% of patients [10]. This usually leads to upper and lower gastrointestinal endoscopy, where the cause of the bleeding cannot be found. The clinical manifestations that can occur are abdominal pain (68%) and intussusception (39%) [14].

Risk factors for an increased risk of developing symptoms include age younger than 50 years, male sex, a diverticulum greater than 2 cm in length, the presence of ectopic tissue, a broad-based diverticulum, and fibrous bands attached to the diverticulum (2).

Preoperative diagnosis of symptomatic Meckel’s diverticulum remains a significant challenge [15]. This is particularly true in patients who present with symptoms other than bleeding. In a study of 776 patients by Kusumoto et al., 88% of patients presenting with bleeding had a correct preoperative diagnosis versus 11% with symptoms other than bleeding [16]. The preoperative diagnosis of Meckel’s diverticulum is still an outstanding challenge—we often encounter cases that are misdiagnosed or not diagnosed preoperatively. In doubtful cases, laparoscopy is a preferred diagnostic modality [17]. However, technetium-99 m pertechnate scanning is the most common and accurate noninvasive method performed for these patients [18].

For diagnostic tools, abdominal ultrasonography can contribute to the diagnosis but often yields nonspecific findings, such as a thickened intestinal wall, fluid fille target or distended loops of the bowel [19, 20].

One of the most useful tools is computed tomography (CT) scan, which usually shows a thickened small intestinal wall, with an elongated, intraluminal, fat-attenuating lesion [21], as in our case. In the case of intussusception, a computed tomography (CT) scan is especially useful, as it can reveal the characteristic “target sign”. Inverted Meckel’s diverticulum is sometimes confused with a lipoma on computed tomography (CT) scan because it also consists of macroscopic fatty tissue. However, in most cases, abdominal computed tomography (CT) scan provides useful information for the diagnosis and treatment of inverted Meckel’s diverticulum [22].

Capsule endoscopy has recently been considered a useful diagnostic tool for diagnosing Meckel’s diverticulum [23,24,25]. However, the role of capsule endoscopy in the identification of Meckel’s diverticulum is not yet clear, with only a few case reports and case series available. Furthermore, in the case of inverted Meckel’s diverticulum, the information is very limited, represented by only 2 case reports [26, 27]. The capsule findings compatible with inverted Meckel’s diverticulum were described as elevated lesions with normal mucosa [26] or as pedunculated polyps [27].

The table summarizes how often, although the total number of cases is small, mesenteric Meckel’s diverticulum cases are misdiagnosed, as they present with a variety of nonspecific symptoms. However, once intraoperatively encountered, patients with mesenteric Meckel’s diverticulum underwent similar approaches for treatment.

Surgery is the treatment of choice for symptomatic Meckel’s diverticulum, and the traditional procedure is open diverticulectomy or segmental bowel resection and anastomosis, depending on the length of the Meckel diverticulum and the location of the ectopic mucosa [45, 46]. The general consensus is that it should be treated with resection [45, 46]. In the case of asymptomatic Meckel’s diverticulum, there is some debate. Resection is generally recommended for patients younger than 40 years, with a diverticulum longer than 2 cm, diverticula with narrow necks, fibrous bands, and/or ectopic gastric tissue, and/or when the diverticulum appears thickened and inflamed [12,13,47].