Although the appendiceal orifice is routinely identified during a total colonoscopic examination, there are only a few reports in the English literature describing abnormalities in this region. Many recent case reports have described endoscopic features of various appendiceal pathologies. In order to increase the awareness as well as facilitate the recognition of these uncommon encounters a review of the literature on the endoscopic features of various appendiceal problems is provided. The most frequently reported abnormalities are related to appendiceal neoplasms or intussusception. Interesting observations and new features of appendiceal regional abnormalities in acute appendicitis and ulcerative colitis are being described. Importance of appendiceal involvement in ulcerative colitis is of interest in particular. This may have impact on the disease prognosis and management. The knowledge of the emerging role of colonoscopy in the diagnosis and management of complicated appendicitis might encourage a more aggressive non-operative approach in some of these cases. Recognition of rare entities requires knowledge of their endoscopic appearance. Awareness of these new developments is essential for all endoscopists performing routine colonoscopic examination. In order to detect any abnormality, the appendiceal orifice should be carefully inspected during all routine colonoscopic examinations. This systematic approach may eventually result in more frequent pre-operative diagnosis of appendiceal problems.