Abstract A 63 year old woman, presenting as an emergency provides an useful example of the difficulties in diagnosing acute appendicitis when faced with an atypical history. This patient underwent plain radiography, computed tomography, repeat biochemical investigations and finally an exploratory laparotomy before the diagnosis of acute appendicitis was made. The case was confounded by a highly mobile caecal pole which brought the inflamed appendix to lie over the pancreas highlighting the need for vigilance in diagnosing acute appendicitis.