A 60-year-old woman presented to the accident and emergency department with a 3-day history of lower abdominal pain, which was sudden in onset, localised to the right iliac fossa, constant and aggravated by movements. On examination, she was febrile (100 · F), tachycardic and normotensive. Examination of the abdomen revealed an ill-defined tender mass in the right iliac fossa. A clinical diagnosis of appendicular mass was made and treated conservatively. After a few days the mass became smaller, firmer, mobile and non-tender. Since the mass persisted, the patient was investigated further to rule out carcinoma of the caecum. A contrast-enhanced CT (CECT) of the abdomen showed a mass with air pockets in the caecum, suggestive of caecal faecolith. After 6 weeks, appendicectomy and removal of the faecolith were performed. The postoperative period was uneventful. Histopathology of the appendix showed inflammatory changes confirming appendicitis.