The patient is a 62 year old male who had a history of hepatitis C cirrhosis complicated by hepatocellular carcinoma. He underwent a liver transplant, for which required re-transplantation just a year after his initial surgery. He presented with perforated appendicitis that was initially managed with antibiotics and percutaneous drainage. This resulted in resolution of his symptoms. Simultaneously, the patient was diagnosed with aortic valvular insufficiency for which he would need to undergo aortic valve replacement. He was referred to our clinic for evaluation for an interval appendectomy. This was due to increased risk of recurrent appendicitis as the patient was on immunosuppression and concern for future prosthetic valve infection. Of note, in addition to his prior transplants, the patient had also undergone two subsequent ventral hernia repairs with mesh. His physical exam was relatively unremarkable. His abdomen was soft with no tenderness to palpation and he has a number of well healed scars.