Acute appendicitis in an elderly patient treated with choyoto in combination with conservative antibiotic therapy

Abstract

Case: A male patient in his 70s was brought to the hospital with as chief complaint fever and difficulty in moving. Abdominal computed tomography revealed early acute appendicitis with fecaliths, and conservative treatment with antibiotics was started. On day 4, the patient started taking choyoto. Outcome: Although his symptoms did not exacerbate, contrast-enhanced computed tomography showed that the lumen of the appendix remained slightly enlarged, suggesting an appendiceal tumor. The patient refused further examination and was discharged on day 34 while continuing as an outpatient. Conclusion: Conservative treatment without surgery for acute appendicitis is risky in the elderly because of the possibility of a malignancy and because the severity of the disease tends to be underestimated. On the other hand, the risk of postoperative complications is high due to comorbidities. Therefore, In order to solve this dilemma, the effectiveness of the combination of Kampo medicines with conservative antibiotic therapy in improving symptoms and preventing recurrence should be verified.