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Introduction: Colonic lipomatosis is defined as a poorly circumscribed, non-capsulated fat accumulation in the submucosal layer of the colonic wall. Clinical presentation varies from asymptomatic to acute surgical complications., Presentation of Case: We report the case of a 79-year old male who arrived at the Emergency Department complaining of worsening abdominal pain, fever and nausea. A CT scan revealed a periappendicular abscess extended to the ileocecal valve and also the presence of diffuse intramural fatty tissue of the ascending colon. The patient underwent surgery and a right hemicolectomy was performed. The final histological exam confirmed the diagnosis of gangrenous appendicitis with diffuse abscessualization of the ileocecal valve and the presence of submucosal lipomatosis of the ICV extending to the ascending colon. Patient was discharged at 11th-POD., Discussion: Acute appendicitis can represent a complication, although rare, of colonic lipomatosis. The underlying mechanism can be explained by the obstruction of the stool discharge from the appendix caused by the thickened colonic wall due to lipomatosis. Despite the lack of established guidelines on the management of colonic lipomatosis, surgery remains the preferred treatment in case of acute complications., Conclusion: Acute appendicitis is a rare clinical manifestation of colonic lipomatosis. As in the case of other acute complications, such as intussesception, surgery remains the preferred therapeutic approach., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)