Background: Acute appendicitis is a frequently encountered entity in emergency surgery. Incidental findings as Meckel's diverticulum or Crohn's disease during this operation are not uncommon.

Methods: Laparotomy revealed a perforated appendix with an incidental Meckel's diverticulum and thickened distal small bowel with fat encroaching the mesentery suggestive of active Crohn's disease. A routine appendicectomy was done and pathology revealed inflamed perforated appendix with an incidental carcinoid within the appendix.

Conclusions: Presence of active Crohn's disease along with an incidental Meckel's diverticulum or acute appendicitis raises controversies in their surgical management. We discuss the issues in managing patients with two or more of these co-existent pathologies.