Epiploic appendagitis (EA) is a rare cause of right lower quadrant (RLQ) abdominal pain. We report an unusual case of acute gangrenous appendicitis that developed after laparoscopic treatment of an EA. A 62-year-old man underwent laparoscopy for RLQ abdominal pain. EA was found and a resection was performed. The appendix, which was macroscopically normal, was left undisturbed. One week later, the patient was operated on for acute gangrenous appendicitis. Histologic examination separately confirmed both diagnoses. The definitive outcome was uneventful. The exact origin of this unusual case is unknown: Could acute appendicitis have been secondary to laparoscopic manipulation or initially missed? We conclude that acute appendicitis may be either missed or induced by laparoscopy for RLQ abdominal pain.