A 49 years old diabetic Saudi man presented with a clinical picture typical of acute appendicitis with mild 
fever but marked leucocytosis. He had no history of recent change in bowel habits. Under clindamycine, 
cefotaxime and metronidazole umbrella, appendectomy was planned through a Gridiron incision. At 
operation a hard friable cecal mass was found incorporating a perforated inflamed appendix. Right 
hemicolectomy was performed after changing the incision to a paramedian one. Gross examination of the 
specimen showed an ulcerated cecal tumour extending few centimetres in the ascending colon and involving
the ileocecal valve. Microscopically it was moderately differentiated invasive adenocarcinoma and the 
tumor was staged as Duke's – C with lymph nodes free of deposits. He subsequently received chemotherapy
by Folfox protocol. 
Cecal carcinoma presenting as acute appendicitis is a recognized operative entity in the elderly but may be 
overlooked in younger patients less than 40 years. It is recommended to do colonoscopy as a routine 6 
weeks after appendectomy for patients belonging to this category.