Acute appendicitis management in the elderly is challenging due to increased surgical risks. Endoscopic retroverse appendicitis therapy (ERAT) offers a minimally invasive, organ-preserving alternative.An 85-year-old male with acute appendicitis underwent successful ERAT assisted by a digital single-operator cholangioscope (DSOC). The procedure involved DSOC-guided visualization, saline irrigation of the appendiceal cavity, and stent placement. Postoperative CT scan showed significant improvement, and his inflammatory markers normalized within four days. No recurrence was observed during six-month follow-up.As the oldest reported case utilizing this technique, it demonstrates that DSOC-assisted ERAT is a viable and effective treatment for acute appendicitis in elderly patients, promoting faster recovery and preserving appendiceal function.