A 70-year-old male patient was admitted to the hospital on 2 separate occasions with small-bowel obstruction, which settled spontaneously with conservative management. In the course of investigation, a colonoscopy showed severe diverticular disease of the sigmoid colon and a small tubular adenoma of low-grade dysplasia at the hepatic flexure. A computed tomographic scan showed a large fluid-filled structure extending inferomedially from the cecal pole (Figure 1). An elective open appendectomy was performed (Figure 2). The wall of the appendix was smooth and thickened with no areas of roughening and no externally attached mucous. No fecalith was felt. His postsurgical recovery was complicated by a left middle cerebral artery territory infarct.