Abstract
A 42-year-old lady presented to emergency department with a 3 days history of right-sided abdominal pain. She was afebrile, haemodynamically unstable and the initial diagnosis was acute abdomen with unknown pathology. The CT abdomen/pelvis done, which showed well-defined fatty texture at right lower quadrant suggestive of an epiploic appendagitis and left adnexal cyst. The patient failed to improve on conservative management, diagnostic laparosocopy showed gangrenous sigmoid epiploic appendigitis adherent to the right lower quadrant. Excision of the gangrenous appendigitis done along with deroofing of left ovarian cyst. Postoperatively the patient significantly improved and discharged home. This case is an extremely rare case of right lower quadrant pain. It demonstrates the importance diagnostic laparoscopy in all patients failed to improve on conservative management with presumed appendigitis.