Diagnosis of the disease in pregnant women pre- senting with acute abdominal disease is difficult. The anatomical and physiological changes of preg- nancy may lead to changes in the clinical course which may require surgical intervention. In this case we report the clinical course of a pregnant patient who had both acute appendicitis and ürolithiasis, to emphasize the importance of a complete history, physical examination and differential diagnosis. For the correct diagnosis and appropriate treatment to be done, careful and thorough physical examina- tion is a must. The clinical presentation of this case displays features to be considered in the practice of emergency medicine.