
There can be many differential diagnosis of abdomino pelvic mass in young girls. Germ cell ovarian tumors which are the common ovarian malignancy of young age, which may present as acute abdomen. Likewise other surgical conditions may also present as large pelvic masses. Case: We herewith report a case of 20 year old unmarried female who presented with acute abdomen and a large abdominopelvic mass. Ovarian torsion was ruled out by doppler but high suspicion of ovarian malignancy was there as CA-125 was raised (371.4IU/ml). CECT findings were suggested of a large mass with undefined ovary margin. She developed jaundice and repeat MRI was done which showed large mass with bowel perforation with gas under diaphragm. Exploratory laprotomy was done by surgeons and to everyone’s surprise, patient turned out to be a case of appendicular lump which had perforated. Patient improved in postoperative period. Conclusion: In cases of large abdominopelvic masses, surgical causes should always be kept as differential as even advanced imaging modalities may not be diagnostic. Multidisciplinary approach may be beneficial.