Diagnostic Challenges in Right Iliac Fossa Mass Caused by a Fish Bone

Right iliac fossa (RIF) mass is a common condition seen by surgeons. Despite advances in diagnostic modalities, it remains a diagnostic and therapeutic challenge, hence many authors describe RIF mass as temple of surprises. We report a challenging case of a 35-year-old man who presented with a tender RIF mass. Abdominal ultrasonography (USG) and computed tomography (CT) scan abdomen were done and he was treated nonsurgically. His symptoms recurred after one month and a CT scan abdomen was repeated which revealed a suspicious foreign body within the appendicular mass. Laparotomy was performed which showed a macerated appendix with a 4-cm long fish bone within. The role of diagnostic tools in managing RIF mass and the treatment modality of appendicular mass are discussed. In managing RIF mass, a surgeon must be aware of the various differential diagnoses, but common diagnosis should always be entertained. Multi-modal diagnostic tools must be considered, including serial imaging in different planes.