We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.