An 11 1/2-year-old African-American male presented with a 3-day history of abdominal pain that was constant, dull, and localized to the right lower quadrant. It was associated with anorexia, bile-stained vomiting, and enema-relieved constipation. His white blood cell count was elevated and the serum was lipemic. He had an immediate appendectomy, which revealed purosanguinous fluid in the peritoneal cavity. Postoperatively his triglycerides and total cholesterol were markedly elevated, and his pancreas was enlarged and poorly delineated, with no pseudocysts. He was diagnosed with type V primary hyperlipidemia and placed on gemfibrozil regimen. He was compliant with medication and made dietary changes, which all contributed to lower cholesterol and triglyceride levels.