Aim: A rare presentation of fish bone as a foreign body in a patient with pain and lump left side abdomen which intra-operatively was discovered to be a sealed off perforation. 

Background: Fish bone most common form of foreign body in the upper GI tract is an emergency but in 80-90 percent of the cases the foreign body passes through the intestinal canal naturally ,but in 10-20 percent of the cases a non –invasive intervention is necessary but in 1 percent of the cases surgery is required when severe complications arise such as intestinal obstruction ,perforation, bleeding ,ulcer and peritonitis and can even cause death. 

Case Description: Here we present a patient who presented to us with severe pain abdomen since 2 – 3 days with no history of fever and recently noticed lump left side of abdomen with redness and tenderness on palpation. As upper GI scopy and CT scan were quite inconclusive patient was taken for an emergency laparoscopic exploration which revealed a sealed off perforation with intraperitoneal abscess and a fish bone as a foreign body in inflamed omentum. 

Conclusion: Even if the patient does not present with all the features of acute abdomen, and if the endoscopy and imaging are inconclusive there should be a very low threshold for surgical exploration laparoscopically to save the patient from dire complications and consequences. 

Clinical significance: This case highlights that surgical intervention remains the mainstay and the earlier the better for an acute abdomen case wherein endoscopy and radiology are also inconclusive.