Appendicitis classically presents in a young adult as periumbilical pain localizing to the right lower quadrant as a result of an obstruction of the appendiceal orifice from lymphoid hyperplasia, fecalith, or infection. Persistent obstruction predisposes the appendix to an increasing inflammation, which may manifest as peritoneal signs as the disease course progresses toward perforation. Rarely, this obstruction occurs secondary to neoplastic growth, such as colonic adenocarcinoma. Furthermore, in older patient populations, appendicitis may not present with strict right lower quadrant pain. In this case report, we discuss an atypical presentation of perforated appendicitis with an underlying etiology of colonic adenocarcinoma in a 68-year-old male.