Intestinal malrotation is a rare pathological situation consisting of non-rotation or incomplete rotation of the primitive intestine. Due to the abnormal caecal position inflicted by malrotation, diagnosis of acute appendicitis is difficult. Ultrasonography (US) and Computed Tomography (CT) are relevant and complementary imaging techniques for establishing an otherwise elusive diagnosis. We present the case of 54 year old male presenting with nonspecific abdominal complaints in which US (standard and contrast enhanced) and CT scans identified acute appendicitis associated with malrotated caecum and ascending colon, located in the left hipocondrum.