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Acute appendicitis is one of the most common surgical emergencies worldwide. The diagnosis is usually a clinical one, supported by laboratory and radiological investigations as required. However, atypical clinical presentation and imaging can cause diagnostic confusion. Possibility of appendicolith in imaging in presence of abdominal pain and no urological pathology warrant diagnostic laparoscopy to rule out appendicitis, as appendicoliths are associated with complicated appendicitis particularly when they are large. We report a case of a 24-year-old male patient with clinical presentation suggestive of urological problem, and the imaging showed unusual large opacities in right lower abdomen with possibility of foreign body in small bowel or large fecalith. A diagnostic laparoscopy was performed where perforated appendix with large fecalith was confirmed.

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