The patient hid the incident of inserting a foreign body in the anus.

The CT picture was evident for peritonitis which is more than expected in a simple case of acute appendicitis. The possibility of rectal wall perforation was questionable, especially in the absence of any relative clinical history.

The patient was subjected to laparoscopic exploration which revealed severe peritonitis, inflamed appendix probably secondary, and free fecal contents in the para-rectal regions. Open laparotomy was done immediately and confirmed the anterior wall rectal perforation. Hartmann's procedure with colostomy was done.

It is an example of the degree of difficulties facing physicians and radiologists if the patient hid his clinical history, especially the traumatic one.