Primary tumors of the appendix, specifically appendicular adenocarcinoma, are a rare malignant neoplasm of the gastrointestinal tract. We present a case of a 64-year-old female who had significant peritoneal adhesions from a previously perforated appendix involving the right ureter, bladder, and anterior abdominal wall after a course of perforated appendicitis, which was managed conservatively with drain placement with interval appendectomy. We are discussing this case in hopes of bringing awareness to the possibility of underlying malignancy in the setting of perforated appendicitis in patients of advanced age.