gastrointestinal tract’s mucosa. The ability to express proteins usually associated with neural cells, such as neuron-specic enolase and synaptophysin, and the abil­ity to produce hormones like somatostatin, substance P, and vasoactive intestinal peptide, gives these cells their name. Sixty-four percent of all NETs are thought to start in the gastrointestinal system, whereas 28% begin in the lungs and bron­chi. The small intestine (29%), rectum (14%), stomach (5%), and appendix (5%) are the most often aficted areas within the gastrointestinal system [10, 12]. Irritable bowel syndrome [11] is a rare tumor form, and 60% of individuals with NETs are asymptomatic and discover their tumors by chance during medical workup for something else [10]. Lesions are typically >2cm in diameter at diag­nosis, with the invasion of the muscularis propria and metastases to regional lymph nodes if they are not an accidental observation. Even in the absence of a visible abdominal mass, midgut NETs are associated with mesenteric brosis, which can compress mesenteric arteries and produce bowel ischemia and malab­sorption [26]. Multiple lesions are discovered in up to 40% of patients [15]. The annual incidence of NETs has risen from 40 to 50 cases per million in recent years, owing to improved diagnostic tools that have become increasingly avail­able [29]. This is likely not due to an actual increase in incidence but rather to better diagnostic tools increasingly available. The evaluation of a female patient in the emergency department frequently results in a diagnostic difculty, as evi­denced by numerous studies [1, 16–19, 24, 25, 32], to name a few instances. CT or ultrasound imaging, on the other hand, proved helpful in all of those cases in determining an accurate diagnosis. In our situation, an ultrasound scan performed during the patient’s initial presentation revealed what was termed as “complex uid,” but no tumors were visible. A transvaginal scan revealed a mass in the pouch of Douglas on her second presentation, which was misinterpreted as an adnexal mass given her previous diagnosis of PID.It was later discovered that the abscess, not the tumor, was the source of the inammatory mass seen intraopera­tively. Despite the prior discussion, the transvaginal ultrasound images could not be connected to the CT scan, which only revealed nonspecic intestinal altera­tions and hence could not aid in the accurate diagnosis. Our case shows that, despite advances in diagnostic tool development, rigorous history taking and clin­ical examination remain essential and cannot be replaced solely by imaging.