Summary

We report a 59-year-old lifelong smoker with severe chronic obstructive pulmonary disease who presented with an acute onset 3-day history of left iliac fossa pain and abdominal distension. Clinical examination revealed a palpable mass in the left iliac fossa. The differential diagnosis was that of a diverticular abscess or colonic tumour. She subsequently underwent a CT scan which showed extensive metastatic liver disease from a primary lung tumour, with hepatomegaly abutting the anterior abdominal wall in the left iliac fossa.