Acute appendicitis with fecaliths requiring surgery in a patient with COVID‐19 successfully treated with daiobotanpito and antibiotics

Abstract

A 29-year-old man visited a previous doctor because of fever; he was diagnosed with COVID-19 and underwent home care. On the fourth day, he visited the emergency department of a hospital owing to difficulty with oral intake and abdominal pain. The patient had marked tenderness mainly in the right lower quadrant of the abdomen and localized muscle guarding. He had difficulty walking on his own owing to the right lower abdominal pain. The following were the Kampo medical findings: absence of tongue swelling, prominent sublingual veins, intermediate floating and sunken pulse, and strong abdomen. Based on Kampo medicine, he was diagnosed with blood stasis and an excess heat pattern. Laboratory findings revealed normal white blood cell (WBC) count (7100/μl) and C-reactive protein (CRP) level (0.31 mg/dl). However, computed tomography (CT) revealed acute appendicitis with fecaliths (Figure 1a). Emergency surgery was required; however, all hospitals in our prefecture that could perform emergency surgery were unable to accept him. Therefore, he was managed conservatively and received daiobotanpito (DBT; extract TJ-33, Tsumura, Tokyo, Japan)