An accessory liver lobe (ALL) is the presence of ectopic hepatic tissue which has developed as a result of excessive hepatic development. The majority of patients with ALL remain asymptomatic and their findings are incidental, either after undergoing radiological imaging or during surgery for other pathology. However, in a small number of patients who have a pedunculated ALL, torsion of the lobe on its axis can cause pain, often due to ischaemia of the lobe. We report a 26-year-old female who presented with right iliac fossa pain mimicking acute appendicitis and preceded by recent vigorous exercising activity.