Background: Diagnosis of acute appendicitis continues to be a real challenge in clinical setting. The recurrence or persistence of pain in the right lower abdomen following appendicectomy is known as post appendicectomy syndrome. This is mainly duetopreoperative misdiagnosis (or over diagnosis) and/or postoperative complications. Negative appendicectomy (appendicectomy in the absence of appendiceal disease) rate has been on the rise. In this study, we looked at patients with recurrent orpersistent right iliac fossa pain post-appendicectomy and investigated the potential causes for this. Patients and methods: A prospective study, 47 post-appendicectomy patients presented to Duhok Emergency Hospital, Kurdistan region, Iraq with recurrent or persistent right iliac fossa pain (January 2017-January 2019). Detailed history taking and clinical examination, as well as appropriate investigations were undertaken as well as review of the previous admission records, investigations, surgical notes and histopathology reports. Results: Clinical assessment and investigations confirmed the presence of primary cause, other than acute appendicitis or appendectomy-related, for the pain (negative appendicectomy). These included: gastroenterological and inflammatory (lymphadenitis, adhesions, stump appendicitis, familial Mediterranean fever, and perforated duodenal ulcer), gynaecological (ovarian cyst, dysmenorrhea, polycystic ovary syndrome), urological (renal stones, ureteric stone, acute right pyelonephritis) and locomotors (disc prolapsed). In 22 patients, no surgical cause was found and a diagnosis of functional pain was given. Conclusion: In our study, we have managed to identify the causes of negative appendicectomy. We could not quantify the incidence of such cases but do recognise that these cases raise a question about how to improve diagnostic accuracy. Until now, no diagnostic tool could give a 100% accurate diagnosis but rather a combination of clinical judgement following history and appropriate examination and investigations.