Congenital lobar overinflation, also known as congenital lobar emphysema (CLE), is an uncommon (1/20,000-30,000 live births) abnormality characterized by hyperinflation of one or more pulmonary lobes, usually with contralateral displacement of the mediastinum.

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Appendicitis is an exceedingly uncommon diagnosis in infancy and, thus, is typically not considered a differential diagnosis for this population. Its atypical presentation, with a wide range of clinical manifestations, creates a diagnostic challenge for physicians. Along with this, a patient's inability to articulate their pain adds another layer of diagnostic challenge. Here, we present the case of a six-monthold infant with a complicated hospital course of pneumonia and subsequent ileus, who was later found to have appendicitis with a surrounding abscess.