Foreign body (FB) ingestion results in perforation in 1% of cases and is associated with significant morbidity and rarely mortality. This case reports the delayed presentation of distal ileal perforation following accidental ingestion of solidified root pulp. A 46-year-old male presented to the emergency department with complaints of right iliac fossa pain, clinical diagnosis of appendicitis was made. Computed tomography of the abdomen revealed an FB in the distal ileum with contained perforation. Revised history was suggestive of FB aspiration during root canal therapy 3 weeks back. The patient underwent diagnostic laparoscopy, removal of FB and primary closure of the perforation. FB was revealed to be solidified root pulp macroscopically and hyalinised material microscopically. Localised perforation following ingestion of FB results in significant morbidity due to delayed diagnosis. With the increasing number of dental procedures, this becomes relevant globally as well. Varied clinical presentations pose diagnostic challenges to the clinician.
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