Introduction: Acute appendicitis during pregnancy is challenging to diagnose due to anatomical and physiological changes. Delay in diagnosis can increase maternal morbidity and foetal loss. Surgical management is necessary however the use of laparoscopy in pregnancy remains limited despite evidence of safety and advantages. Case Presentation: A 20-year-old primigravida at 19 weeks gestation presented with right-sided abdominal pain and nausea. Clinical examination was equivocal and ultrasound was inconclusive. Had persistence of symptoms despite bowel rest and antibiotics with worsening abdominal pain thus underwent diagnostic laparoscopic which revealed appendicitis thus appendectomy done with appropriate intraoperative precautions. Recovery was uneventful, with no maternal or foetal complications. Discussion: Diagnosis of appendicitis in pregnancy is hampered by altered pain localization, physiological leucocytosis, and limited ultrasound accuracy. Magnetic Resonance Imaging may improve diagnostic accuracy. Persistence of symptoms with clinical suspicion for appendicitis warrants laparoscopic evaluation and laparoscopic appendectomy offers advantages of faster recovery, lower infection risk, and better visualization of displaced anatomy. Despite guideline endorsements, concerns about foetal safety continue to limit its use. Conclusion: This case emphasizes the role of clinical suspicion of appendicitis during pregnancy and supports wider adoption of laparoscopy as a safe and effective surgical option when performed by an experienced team. This case highlights diagnostic complexities however illustrates successful laparoscopic approach in Tanzania.