Appendectomy is one of the most common surgical procedures performed in the United States. Residual appendiceal tissue left at the time of appendectomy may predispose to the rare development of stump appendicitis. Patients typically are seen with signs and symptoms similar to appendicitis; however, the diagnosis is often delayed owing to the low index of suspicion, which may result in perforation. We describe a patient with recurrent appendicitis after previous appendectomy and review the pertinent literature regarding this diagnostic dilemma.