Abstract A 46-year-old fit and well lady who had an open appendicectomy at the age of 14 was seen in ED with abdominal pain and generally feeling unwell. On examination, she had generalised abdominal pain with guarding and features of peritonism. CT abdomen and pelvis were performed that reported as localised perforation and abscess formation at the bed of appendicectomy. A laparoscopy was then performed and she was found to have an inflammatory mass in the RIF with a large abscess cavity. There was purulent fluid in the RIF and pelvis. There was perforation of the appendicular stump with faecal peritonitis. The stump was suture repaired. She had an uneventful post-operative recovery and was discharged home on the 3rd post-operative day.