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With an occurrence of 7%, appendicitis is one of the most common abdominal emergencies requiring surgery. Since the variation in positions and length of the appendix may produce varying symptoms and signs which mimic other diseases, having knowledge of the variations in the position of the appendix is of significant importance.

Here, we present a 77-year-old man with acute appendicitis presenting with lower abdominal pain, fever, chills, and dysuria. Physical examination revealed tenderness and rebound tenderness in the left lower quadrant more pronounced in the right lower quadrant with leukocytosis on blood tests. Both ultrasonography and abdominopelvic computed tomography scan demonstrated a severe inflammation at paracecal mesenteric fat with extension to para sigmoid portion which was in favor of diverticulitis rather than appendicitis. A 2-week treatment with intravenous antibiotic regimen was initiated for the patient and from the second day of antibiotic therapy, the patient’s fever and abdominal pain improved. A second CT-scan performed three weeks after completion of a 14-day course of antibiotics, revealed a dilated long appendix (diameter: 12mm, length: 10 cm) with extension of its tip to the medial wall of sigmoid. Physicians should consider appendicitis when evaluating an acute abdomen to prevent any delay in diagnosis of atypical presentations and decrease the mortality and morbidity related to the complications.