Chronic myeloid leukemia (CML) is rare in children, accounting for 2-3% of pediatric leukemias. We present a case of a 10-year-old with acute appendicitis leading to the incidental discovery of CML. Due to concerns about leukostasis and tumor lysis syndrome, immediate surgical intervention was deferred in favor of medical management with antibiotics and hydroxyurea, followed by appendectomy once the leukocytosis improved. This case highlights the successful use of medical management as a bridge to surgery, providing novel insights into management of co-occurring appendicitis and CML in pediatric patients.