Right iliac fossa pain is a common acute general surgery presentation, and computer tomography (CT) is often used as an aid in determining the diagnosis. CT can play an important role in differentiating malignant and inflammatory causes of caecal wall thickening if certain key features are identified. Two patients with similar presentations of right iliac fossa pain had pre-operative CT, which showed inflammation and caecal thickening, the first was focal with homogenous enhancement, and the second eccentric with stratification. At operation, these were proven to be malignant and inflammatory caecal thickening. Although the clinical presentation of appendicitis and caecal carcinoma may be similar, and the correct recognition and interpretation of differentiating CT characteristics enables the patient for an appropriately tailored operation.
