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Acute urinary retention is a fairly common presentation in the elderly but it is a rare manifestation of acute appendicitis in a healthy young individual. We presented a 32-year-old male with decreased urine output with mild tenderness at the suprapubic region later on shifted to right iliac fossa. Computed tomography of abdomen showed acute appendicitis. Emergency physicians should recognize the uncommon presentation of acute appendicitis and should be aware of this common complaint as a rare presentation. This case also highlights the importance of repeated abdominal examinations to seek diagnostic clarity.