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This case outlines the emergency department and surgical course of a 63-year-old male presenting with acute onset abdominal pain. Appendicitis was high on the differential for the treating physician, but after the computed tomography and laboratory evaluation were unremarkable, the patient was discharged only to return the next day. What ensued was one of the rarest cases of missed appendicitis documented in the medical literature. [West J Emerg Med. 2014;15(7):-0.]