Patient is a 27 year old G2P1 21 week gravid female who presented to the emergency room with abdominal pain. Her history and exam were concerning for acute appendicitis. An ultrasound was obtained which was negative. Given her continued pain an MRI was ordered. It was notable for appendicitis with possible peri-appendiceal abscess and a small amount of free fluid. Due to the increased risk of spontaneous abortion with perforated appendicitis, informed consent was obtained, and the patient was brought emergently to the operating room for diagnostic laparoscopy and appendectomy. Upon entry to the abdomen the appendix was identified and did not appear inflamed. Instead a loop of bowel was noted to be adherent to another loop, and with blunt dissection a perforated Meckel's diverticulum was identified. The diverticulum as well as the appendix were both removed. The patient was extubated and her post-operative recovery was uncomplicated. Her final pathology was notable for both acute appendicitis and Meckel's diverticulitis. As far as we know this is the only case report of simultaneous pathologies in a pregnant patient.