A 13-year-old female from Mornington Island presented with diarrhoea, vomiting, and abdominal pain. Laparoscopic investigation was performed and a gangrenous appendix removed. Histological examination was initially unremarkable, but a later review of the periodic acid-Schiff (PAS) stain demonstrated several areas of PAS-positive bodies consistent with invasive Entamoeba histolytica. Further testing was performed to confirm the diagnosis of E. histolytica, including serology and PCR from paraffinised tissue. The patient was treated with metronidazole and paromomycin to ensure treatment of both tissue and luminal phases of the parasite. This case highlights an unusual presentation of E. histolytica infection, and serves as a reminder that endemic transmission of this parasite is not only possible, but becoming increasingly recognised.