Co-existent appendicitis and cholecystitis

Acute appendicitis and acute cholecystitis are common entities, but rarely do they present concurrently. We present the case of a 40-year-old male who arrived at the emergency department with an 18-hour history of non-bilious, non-bloody vomiting, and abdominal pain located to the right upper and right lower quadrants. The patient was taken for a synchronous laparoscopic appendectomy and cholecystectomy. We used a total of five laparoscopic ports to successfully complete both procedures. When faced with a rare presentation of seemingly two separate acute processes, a combined laparoscopic approach is both safe and effective. The use of five laparoscopic ports provides optimal exposure for both procedures.