Recently, I had a patient who gave me a hard time. The other day, a friend of mine called me and told me that his friend’s relative was diagnosed with “appendiceal abscess” and had been hooked up to water for more than a month, but he was still not well, so he asked me to take a look. When Zhu Feng from the Department of Hepatobiliary Surgery of the First People’s Hospital of Changzhou City received this patient, my heart cackled. Appendiceal abscess, anti-inflammatory treatment for a month has not yet healed, is it an appendiceal abscess? Could it be another disease? This patient had a large mass, almost 10 cm, in the lower right abdomen. A CT examination was done and it was liquid inside. However, when the puncture was performed, it was found to be jelly-like material with only a little pus content inside. A bad feeling came to my heart. The patient’s tumor index was elevated in carcinoembryonic antigen (CEA). It was highly suspected to be a malignant tumor at that time. Bowel preparation was done and tumor resection was planned. However, during surgery, it was found that the tumor was indeed a malignant tumor of the appendix, and the tumor was already advanced, adhering to the iliac vessels, ureter and iliac bone in the abdominal cavity and could not be separated, and could not be removed. It was a pity. I remember that there were such cases in other hospitals in the past, also diagnosed as appendiceal abscess, which did not improve with prolonged anti-inflammatory treatment, and later found out that it was also a tumor of the appendix, and there was no chance of surgical resection. Therefore, it is necessary to be cautious when diagnosing appendiceal abscess clinically, and to strengthen observation while treating it. For patients who have been treated with regular anti-inflammatory therapy for one week, if there is no significant improvement in symptoms, the possibility of tumor should be considered. Patients with appendiceal tumor may also have acute appendicitis as the first symptom. I have personally encountered many cases of appendicitis that were found to be appendiceal tumors intraoperatively. Therefore, in cases of diagnosed appendiceal abscess, we should strengthen observation while performing anti-inflammatory treatment, and we should not keep on anti-inflammatory treatment and change antibiotic treatment frequently to avoid delaying the diagnosis and treatment timing.