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Acute appendicitis is the most common presentation of the acute abdomen in the UK. Although in most cases this is an easily reached diagnosis, presentation is not always typical and there are certain other conditions which may mimic appendicitis. Diagnostic adjuncts usually provide the additional information required to make a confident diagnosis; however, in some circumstances, the safest and most reliable course of action is appropriate surgical intervention. A case report is presented of a 43-year-old woman who presented with history of peri-umbilical pain migrating to the right iliac fossa. Following further investigation, with routine blood tests, plain radiographs, ultrasound examination of the abdomen and pelvis, and CT scanning not pointing towards a definitive diagnosis, she eventually underwent a diagnostic laparoscopy which revealed primary omental torsion. An open omentectomy was performed and 2 months on she remains well.

A simple case of appendicitis? An increasingly recognised pitfall