Complicated acute appendicitis in pediatric patients with “empacho” and abdominal manipulation history: case series

Abstract

According to Latin American popular culture, empacho is a gastrointestinal disease caused by excessive intake of cold or under-cooked food. Abdominal manipulation or sobada is one of the popular treatments used for empacho and consists of an abdominal massage, where the skin is rubbed and stretched, applying pressure on the abdomen.

Objectives: To characterize clinical evolution and complications secondary to diagnostic delay in pediatric patients with acute appendicitis, with history of empacho and abdominal manipulation.

Patients and Method: Descriptive, observational, prospective study of pediatric patients with complicated acute appendicitis and history of abdominal manipulation, identified in the pediatric surgery room between November 2019 and June 2020 at the Mario Catarino Rivas Hospital. Descriptive statistics were used for analysis.

Results: 10 patients were studied, aged ranging from 6 to 16 years (median age 14 years). Half of them were from rural areas. The main symptoms that appeared before abdominal manipulation were vomiting, nausea, and loss of appetite, followed by sudden diarrhea or constipation, and increased pain intensity. Complications were gastrointestinal perforation (5/10), appendicular mass (3/10), intra-abdominal abscess (3/10), and gangrenous appendicitis (1/10). The median time between initial symptom and hospitalization was 60 hours [IQR, 33.0 – 72.0].

Conclusion: This study describes the influence of the empacho and its respective treatment on clinical deterioration due to the delay in diagnosis and treatment of acute appendicitis, resulting in different complications.