Febrile occlusive syndrome: When acute pyelonephritis masks a complicated Meckel's diverticulum in newborn

Meckel’s diverticulum is a rare congenital anomaly in newborns that often presents with acute complications. Diagnosis is challenging due to sometimes atypical clinical manifestations, non-specific imaging findings, and the need for prompt surgical intervention. We report the case of a 22-day-old newborn admitted for pyelonephritis suspected in the context of a congenital urinary tract malformation and clinical symptoms consisting of postprandial vomiting accompanied by a fever of 39°C; the CRP was positive and the urine culture was positive. Despite appropriate intravenous antibiotic therapy, the course of the illness was marked by the onset of abdominal distension and bilious vomiting. An abdominal X-ray without preparation revealed fluid-air levels. An emergency laparotomy revealed a Meckel’s diverticulum, which was surgically treated with uncomplicated postoperative outcomes. The presence of heterotopic gastric tissue was confirmed by histological examination. This case illustrates how signs of concomitant pyelonephritis can mask an underlying gastrointestinal condition in newborns or infants. The diagnosis of Meckel’s diverticulum should be considered in any case of febrile intestinal obstruction.