A right iliac fossa mass is a ‘temple of surprises’ and a common presentation at emergency department, requiring skill and keeness to diagnose. Patients with right iliac fossa mass will be dealt by a general practitioner, a surgeon or a gynecologist and knowledge of anatomy, with detailed history, clinical examination directing towards the pathological process followed by lab analysis and imaging leads to a diagnosis.

The most common differential diagnosis encountered are: appendicular mass, appendicular abscess, ileocecal tuberculosis, right ovarian mass, right ectopic kidney, rectus sheath hematoma, carcinoma caecum and ameboma, actinomycosis and crohn’s disease.

An important differential diagnosis is often between an appendicular mass, carcinoma of the caecum and ileocecal tuberculosis.3 In Subcontinent, tuberculosis has been the main cause of intestinal obstruction and perforation.

Cecal carcinoma is more common in the elderly and higher socio-economic group consuming less brous diet.1,5,6 Appendicular masses are seen in relatively younger people with both conservative and operative strategies. Other less common causes are diagnosed and managed accordingly.7