Introduction: Acute abdomen in an elderly, especially in the right iliac fossa, is usually the common symptom that needs a precise surgical assessment with acute appendicitis being a common cause. Rarely, other conditions can mimic this presentation such as acute caecal diverticulitis.1 We describe a rare case of right iliac fossa pain in a 72- year old male which mimicked an acute appendicitis. The ability to recognize such condition is very important as its management is different at various stages. The objective of this case report is to increase awareness of this condition to ensure it is appropriately treated when encountered unexpectedly. Methods and Results: A 72-year old man was admitted with the complaint of right iliac fossa pain for 5 days. A pre-operative clinical diagnosis of acute appendicitis was made. The patient underwent an emergency laparotomy where an inflammatory mass in the caecum was found. A right hemicolectomy was performed as there was a suspicion of underlying malignancy. His histopathology report showed a single inflammatory diverticular mass. Acute caecal diverticulitis has a higher incidence in the Asian descent. In Western countries, more than 80% of all diverticula occur in the left sided colon, whereas the incidence of right-sided diverticular disease in Oriental countries can be up to 75%. The pre-operative diagnosis of right caecal diverticulitis is usually challenging to the surgeons, if without radiological imaging. Ultrasonography (USG) and computed tomography (CT) are the important investigations for the diagnosis with their specific findings. The ability to recognize the condition is very important as its management is different at various stages. The morbidity and mortality can be improved by earlier detection and proper management. Conclusion: Acute caecal diverticulitis should be considered in the differential diagnosis in elderly with right iliac fossa pain. The surgical approach can be range from a simple diverticulectomy to a more complex right hemicolectomy. The decision making should always be tailored to the severity of the condition of the patient.