A rare presentation of acute appendicitis in right upper quadrant caused by renal agenesis.

Diagnosing acute abdominal pain will always be a challenging task, patients frequently present with atypical symptoms. It is crucial for a clinician to have good differential diagnosis to avoid delay in diagnosis and treatment. We present 37-year-old male who presented to emergency department with 2 days of abdominal pain. The pain started centrally around his umbilicus and localized to his right upper quadrant (RUQ). Clinical examination showed he has localized peritonitism on the RUQ hence he was further investigated with CT abdomen. CT revealed he has appendicitis. This is due to the congenital anomaly where he has congenital agenesis of his right kidney. This case illustrates in patients with congenital agenesis of right kidney, the diagnosis of acute appendicitis should be considered in right upper quadrant pain. He was commenced on IV antibiotics and proceeded to have laparoscopic appendicectomy. He had an uneventful post-operative recovery.