Appendicitis is a very common indication for surgery, although in recent years uncomplicated cases have often been managed with antibiotics. In this case, we discuss a patient who presented to the emergency department with a case of seemingly uncomplicated acute appendicitis. Physical exam, history, and imaging indicated that this was due to an ingested foreign body, specifically a dental crown, that had impacted the appendix. In cases of ingested foreign bodies, antibiotics are not an appropriate treatment for appendicitis and all cases should be treated surgically if the patient will tolerate surgery. A thorough history and physical exam, as well as imaging when indicated, can assist in the assessment of such patients.

Primary adenocarcinoma of the appendix is a rare neoplasm, and a large number are found incidentally during abdominal imaging and operations with other indications. This report examines a case of primary appendiceal adenocarcinoma discovered incidentally following a seemingly routine laparoscopic appendectomy in a 69-year-old male. The patient presented with atypical signs of acute appendicitis, including a history of waxing and waning right lower quadrant pain without anorexia, fever, or chills over five days. After undergoing laparoscopic appendectomy, histopathologic analysis of the appendix specimen revealed invasive adenocarcinoma. This case emphasizes the importance of maintaining a high index of suspicion for appendicitis versus appendiceal neoplasm in older adults presenting with atypical signs and symptoms.