Although foreign body (FB) ingestion is common in childhood, most cases do not have any clinical significance. Radiologic evaluation is crucial to determine the exact location of a persistent foreign body because it dictates the therapeutic approach. In this case report, we present a child with appendiceal perforation caused by a FB and emphasize pitfalls in preoperative imaging assessment. A 3-year-old boy presented with subtle abdominal pain duration for three months. The preoperative imaging examinations were consistent with an intraluminal metallic pin. However, the operative findings and postoperative pathological examination showed that the pin perforated the appendiceal wall, causing chronic inflammatory changes with an omental reaction around the extraluminal part of the pin. The patient underwent appendectomy with an uneventful course. Foreign body is a rare cause of appendiceal perforation with resultant appendicitis. Imaging may reveal some clues regarding the location, but the interpretation of radiologic data could be quite challenging.