Acute appendicitis is a common surgical diagnosis but several differential diagnoses exist and should be considered. Internal concealment is one such diagnosis.
We present a case of a young man taken to the operating room with a preoperative diagnosis of complicated acute appendicitis. A ruptured caecum was encountered and several free-floating drug pellets were present.
Attending doctors should consider this differential in the high prevalence areas and, whenever encountered, they should strongly consider early reporting.
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