Acute appendicitis is the most common cause of right iliac fossa pain. However, if the appendix is normal at surgery, the surgeon has to search for other causes of acute abdominal pain including rare etiologies. Awareness of all causes of acute right iliac fossa pain and a high index of suspicion is essential for diagnosis of rare causes like torsion of appendix epiploica In addition, in some patients, two pathologies causing acute pain may coexist. It is to the authors' knowledge that the simultaneous occurrence of torsion of appendix epiploica and acute appendicitis in a patient has not been previously reported, and is therefore discussed in this report.