Acute abdominal conditions unexpectedly present with electrocardiographic changes. However, the presence of electrocardiographic changes and misleading clinical manifestations may obscure true etiology and delay surgical interventions. We present a patient who developed ruptured appendicitis with peritonitis manifested as acute inferior wall myocardial infarction-like electrocardiographic changes. A thorough physical examination and early echocardiographic evaluation helped to differentiate this pseudomyocardial infarction. A 64-multidetector-row computed tomography of the abdomen showed ruptured retrocecal appendicitis, and emergent appendectomy was done. Normalization of ST segments was observed after surgery.