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Fish bone ingestion is a common occurrence, and most cases are uneventful. However, in some cases, fish bones can cause perforation of the gastrointestinal tract. Even with the growing utilization of computerised tomography (CT) imaging and the Alvarado criteria application, the potential for misdiagnosing acute appendicitis persists.This case report describes a patient who presented with abdominal pain and vomiting after ingesting a fish bone. The patient was found to have a perforation of the distal ileum by the ingested fish bone during surgery, which was repaired primarily. The patient made a full recovery. This case report highlights the importance of considering fish bone ingestion in patients with abdominal pain. Early diagnosis and treatment are essential to prevent complications.