1
|
Smith J, Espinosa J, Lucerna A, Lee J, Schuitema H. A Case of Cocaine Toxicity From Body Stuffing. Cureus 2023; 15:e47805. [PMID: 38021695 PMCID: PMC10676734 DOI: 10.7759/cureus.47805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Here, we report a case of body stuffing leading to severe cocaine toxicity. Medical management and supportive care are usually the best course of action in cases of body stuffing, as seen in our case. While surgery is rarely indicated, surgical consultation should occur early to ensure prompt intervention if obstruction or perforation occurs.
Collapse
Affiliation(s)
- Justin Smith
- Emergency Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | | | - Alan Lucerna
- Emergency Medicine, Jefferson Health, Stratford, USA
| | - James Lee
- Emergency Medicine, Jefferson Health, Stratford, USA
| | | |
Collapse
|
2
|
Visentin S, Bevilacqua G, Giraudo C, Dengo C, Nalesso A, Montisci M. Death by heroin intoxication in a body pusher with an innovative packaging technique: case report and review of the literature. Forensic Sci Int 2017; 280:8-14. [DOI: 10.1016/j.forsciint.2017.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
|
3
|
Cappelletti S, Piacentino D, Sani G, Bottoni E, Fiore PA, Aromatario M, Ciallella C. Systematic review of the toxicological and radiological features of body packing. Int J Legal Med 2016; 130:693-709. [DOI: 10.1007/s00414-015-1310-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
|
4
|
Bulakci M, Cengel F. The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools. Br J Radiol 2016; 89:20150888. [PMID: 26867003 DOI: 10.1259/bjr.20150888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Emergency physicians and radiologists have been increasingly encountering internal concealment of illegal drugs. The packages commonly contain powdered solid drugs such as cocaine, heroin, methamphetamine and hashish, but they may also contain cocaine in the liquid form. The second type of package has recently been more commonly encountered, and poses a greater diagnostic challenge. As clinical evaluation and laboratory tests frequently fail to make the correct diagnosis, imaging examination is typically required. Imaging methods assume a vital role in the diagnosis, follow-up and management. Abdominal X-ray, ultrasonography, CT and MRI are used for the imaging purposes. Among the aforementioned methods, low-dose CT is state-of-the-art in these cases. It is of paramount importance that radiologists have a full knowledge of the imaging characteristics of these packages and accurately guide physicians and security officials.
Collapse
Affiliation(s)
- Mesut Bulakci
- 1 Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ferhat Cengel
- 2 Department of Radiology, Haseki Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Nordt SP, Camilon M. Computed Tomography Following Body Stuffing Heroin. West J Emerg Med 2016; 16:1181-2. [PMID: 26759677 PMCID: PMC4703166 DOI: 10.5811/westjem.2015.8.27431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/14/2015] [Accepted: 08/11/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sean P Nordt
- USC Keck School of Medicine, Section of Toxicology, Department of Emergency Medicine, Los Angeles, California
| | - Marissa Camilon
- LAC+USC, Department of Emergency Medicine, Los Angeles, California
| |
Collapse
|
6
|
Reginelli A, Russo A, Urraro F, Maresca D, Martiniello C, D’Andrea A, Brunese L, Pinto A. Imaging of body packing: errors and medico-legal issues. ACTA ACUST UNITED AC 2015; 40:2127-42. [DOI: 10.1007/s00261-015-0469-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
7
|
Thanacoody R, Caravati EM, Troutman B, Höjer J, Benson B, Hoppu K, Erdman A, Bedry R, Mégarbane B. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2014; 53:5-12. [DOI: 10.3109/15563650.2014.989326] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
8
|
|
9
|
Sica G, Guida F, Bocchini G, Iaselli F, Iadevito I, Scaglione M. Imaging of drug smuggling by body packing. Semin Ultrasound CT MR 2014; 36:39-47. [PMID: 25639176 DOI: 10.1053/j.sult.2014.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Body packing, pushing, and stuffing are hazardous practices with complex medicolegal and social implications. A radiologist plays both a social and a medicolegal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location so as to prevent any package remains in the body packer. Radiologists must also be able to recognize the complications associated with these risky practices. Imaging assessment of body packing is performed essentially through plain abdominal X-ray and computed tomography scans. Ultrasound and magnetic resonance imaging, although with some advantages, actually have a limited use.
Collapse
Affiliation(s)
- Giacomo Sica
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Franco Guida
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Francesco Iaselli
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Isabella Iadevito
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy.
| |
Collapse
|
10
|
Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M. Body packing: a review of general background, clinical and imaging aspects. Radiol Med 2014; 120:118-32. [PMID: 25300715 DOI: 10.1007/s11547-014-0458-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
Abstract
To avoid detection at border crossings or airport customs, drug trafficking is increasingly performed by intra-corporeal concealment. Body packers may ingest packets of varying size and containing varying drugs (mostly cocaine, heroin and cannabis) mixed with other compounds, while body pushers will insert packets in the rectum or vaginal cavity. Body packing may lead to potential life-threatening complications with acute overdose syndromes after packet rupture and intestinal obstruction with possible ensuing bowel rupture being the most significant complications. Physicians including radiologists should be aware of the capabilities of imaging techniques to screen for presence of drug packets as well as the potential complications. Although conventional radiography has long been and still is the most important imaging modality for screening for presence of intestinal packets, the better test characteristics in conjunction with the decreasing radiation exposure, will likely render computed tomography (CT) more important in the future. For imaging of symptomatic patients, CT already is the modality of choice. Besides these modalities, ultrasound and magnetic resonance imaging will be discussed in this paper, together with more general background and clinical information.
Collapse
Affiliation(s)
- Ferco H Berger
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands,
| | | | | | | | | |
Collapse
|
11
|
Asha SE, Higham M, Child P. Sensitivity and specificity of CT scanning for determining the number of internally concealed packages in 'body-packers'. Emerg Med J 2014; 32:387-91. [PMID: 24554446 DOI: 10.1136/emermed-2013-203389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/05/2014] [Indexed: 11/04/2022]
Abstract
INTRODUCTION If package counts on abdominal CTs of body-packers were known to be accurate, follow-up CTs could be avoided. The objective was to determine the accuracy of CT for the number of concealed packages in body-packers, and the reliability of package counts reported by body-packers who admit to concealing drugs. METHODS Suspected body-packers were identified from the emergency departments (ED) database. The medical record and radiology reports were reviewed for package counts determined by CT, patient-reported and physically retrieved. The last method was used as the reference standard. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for CT package count accuracy. Reliability of patient-reported package counts was assessed using Pearson's correlation coefficient. RESULTS There were 50 confirmed body-packers on whom 104 CT scans were performed. Data for the index and reference tests were available for 84 scans. The sensitivity, specificity, PPV and NPV for CT package count were 63% (95% CI 46% to 77%), 82% (95% CI 67% to 92%), 76% (95% CI 58% to 89%) and 71% (95% CI 56% to 83%) respectively. For CTs with a package count<15, the sensitivity, specificity, PPV and NPV for CT package count were 96% (95% CI 80% to 99%), 95% (95% CI 82% to 99%), 93% (95% CI 76% to 99%) and 97% (95% CI 86% to 100%), respectively. Correlation between patient-reported package counts and the number of packages retrieved was high (r=0.90, p<0.001, R2=81%). CONCLUSIONS The accuracy of CT for determining the number of concealed packages is poor, although when applied to patients with few concealed packages accuracy is high and is useful as a rule-out test. Among patients who have admitted to drug concealment, the number of packages reported to be concealed is reliable.
Collapse
Affiliation(s)
- Stephen Edward Asha
- Emergency Department, St George Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Higham
- Emergency Department, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Child
- Radiology Department, St George Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, Romano L, Brunese L. Radiological and practical aspects of body packing. Br J Radiol 2014; 87:20130500. [PMID: 24472727 DOI: 10.1259/bjr.20130500] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Body packing represents the concealment of illegal substances in a person's body with the aim of smuggling. "Body packers" either swallow drug-filled packets or introduce drug-filled packets into their bodies rectally or vaginally with the purpose of concealing them. The three main smuggled drugs are cocaine, heroin and cannabis products. Body packing represents a serious risk of acute narcotic toxicity from drug exposure, intestinal obstruction owing to pellet impaction and bowel perforation with consequent abdominal sepsis. A suspected body packer is generally admitted to hospital to perform imaging investigations and confirm the presence of drugs in his/her body. Radiological imaging methods are essential to diagnose body packing and to detect potential complications. Increasing sophistication of traffickers and improvements in packaging add to the detection difficulty. Radiologists should be aware of the appearance of drug packets in a range of imaging modalities. This article informs physicians about the challenging aspects of body packing, its background and medicolegal issues, what imaging methods can be used and what criteria are necessary to perform a correct diagnosis.
Collapse
Affiliation(s)
- A Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Connors NJ, Sekar K, Howland MA, Hoffman RS, Nelson LS. In response to "Detection of body packing by magnetic resonance imaging: a new diagnostic tool?". ABDOMINAL IMAGING 2013; 38:879. [PMID: 23494715 DOI: 10.1007/s00261-013-9994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
14
|
Dinis-Oliveira RJ, Magalhães T. Children intoxications: what is abuse and what is not abuse. TRAUMA, VIOLENCE & ABUSE 2013; 14:113-132. [PMID: 23271430 DOI: 10.1177/1524838012470033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The curiosity and the natural tendency to explore the environment put young children at an increased risk of poisoning over older children and adults. Poisonings are a significant area of concern from 1 year of age and progressively contribute more to overall rates of morbidity and mortality until children reach adulthood. Particularly, the abuse of children by poisoning is also highly common with thousands of fatalities. A practical strategy is presented that aims to alert health, forensic, and law enforcement professionals to this problem and to demystify the preconception that it is a rare form of abuse or neglect. Compounds that are foreign to a living organism (xenobiotics) and those present within body (endobiotics), mainly involved in children intoxications and contextual examples related to exposure are also reviewed. Particular concern is given to concepts in the field of children poisoning. The described history and the clinical and toxicological evaluation are discussed, and harmonized protocols regarding correct procedures for sample collection to forensic toxicological analysis are proposed. Since children are particularly vulnerable to the toxic effects of high doses of xenobiotics and endobiotics, special consideration on the preparation of the environment that surrounds children in order minimize all possible risks will be also considered.
Collapse
|
15
|
Bin Abdul Rashid SN, Rahim ASA, Thali MJ, Flach PM. Death by 'ice': fatal methamphetamine intoxication of a body packer case detected by postmortem computed tomography (PMCT) and validated by autopsy. Forensic Sci Med Pathol 2013; 9:82-7. [PMID: 23404531 DOI: 10.1007/s12024-012-9395-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2012] [Indexed: 02/02/2023]
Abstract
Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA 'body packer' who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication.
Collapse
Affiliation(s)
- Saiful Nizam Bin Abdul Rashid
- Department of Radiology, Faculty of Medicine & Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia.
| | | | | | | |
Collapse
|
16
|
Lee K, Koehn M, Rastegar RF, van Hoorn F, Roy E, Berger FH, Nicolaou S. Body packers: the ins and outs of imaging. Can Assoc Radiol J 2012; 63:318-22. [PMID: 22280790 DOI: 10.1016/j.carj.2011.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 06/14/2011] [Accepted: 06/23/2011] [Indexed: 01/08/2023] Open
Affiliation(s)
- Kristy Lee
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | |
Collapse
|
17
|
Shahnazi M, Sanei Taheri M, Pourghorban R. Body packing and its radiologic manifestations: a review article. IRANIAN JOURNAL OF RADIOLOGY 2011; 8:205-10. [PMID: 23329942 PMCID: PMC3522363 DOI: 10.5812/iranjradiol.4757] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 12/10/2011] [Accepted: 12/15/2011] [Indexed: 11/16/2022]
Abstract
Body packing is described as using the abdominal or pelvic cavity for concealing illegal drugs. Leakage from the packets may cause catastrophic effects on smugglers and medical history is not reliable in these patients. Moreover, new sophisticated smuggling techniques make it imperative that radiologists and emergency physicians understand and familiarize themselves with the different radiological manifestations of ingested drug packets. Currently, there is no gold standard for imaging patients suspected of body packing; nevertheless, computed tomography (CT) seems to be the best modality for packet detection and unenhanced CT without bowel preparation is a reliable technique for detection of ingested packets. On abdominal radiography, packets may be visualized as oval or round radiopaque foreign bodies surrounded by a gas halo. In the literature, sensitivity of abdominal radiography is reported from 74% to 100%. Visualization of the drug packets may be strikingly hampered by administration of oral or intravenous contrast medium in abdomino-pelvic CT; hence, contrast-enhanced CT does not seem to be a suitable modality for searching the ingested packets in suspicious smugglers.
Collapse
Affiliation(s)
- Makhtoom Shahnazi
- Department of Radiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Morteza Sanei Taheri, Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Zip code: 1989934148, Tehran, Iran. Tel.: +98-9121260976, Fax: +98-2122719017, E-mail:
| | - Ramin Pourghorban
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Albertson TE, Owen KP, Sutter ME, Chan AL. Gastrointestinal decontamination in the acutely poisoned patient. Int J Emerg Med 2011; 4:65. [PMID: 21992527 PMCID: PMC3207879 DOI: 10.1186/1865-1380-4-65] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/12/2011] [Indexed: 12/15/2022] Open
Abstract
Objective To define the role of gastrointestinal (GI) decontamination of the poisoned patient. Data Sources A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources. Study Selection and Data Extraction Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient. Data Synthesis The literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials. Conclusions The current literature supports limited use of GI decontamination of the poisoned patient.
Collapse
Affiliation(s)
- Timothy E Albertson
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA.
| | | | | | | |
Collapse
|
19
|
Maurer M, Niehues S, Schnapauff D, Grieser C, Rothe J, Waldmüller D, Chopra S, Hamm B, Denecke T. Low-dose computed tomography to detect body-packing in an animal model. Eur J Radiol 2011; 78:302-6. [DOI: 10.1016/j.ejrad.2010.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/03/2010] [Accepted: 09/06/2010] [Indexed: 11/30/2022]
|
20
|
|
21
|
Abstract
A 42-year-old African male was brought by the police to the emergency department under suspicion of drug smuggling by body-packing. Plain abdominal radiograph showed multiple foreign bodies within the gastrointestinal tract. Contrast-enhanced abdominal CT confirmed the findings, and the patient admitted to have swallowed “balls” of hashish. Body-packing is a recognized method of smuggling drugs across international borders. Body packers may present to the emergency department because of drug toxicity, intestinal obstruction, or more commonly, requested by law-enforcement officers for medical confirmation or exclusion of suspected body packing.
Collapse
|
22
|
Abstract
BACKGROUND To determine if heroin body packing has occurred using computed tomography (CT), and to evaluate the role of CT in screening such cases. METHODS We collected 158 cases of suspected drug packers' imaging materials (all underwent CT, 42 cases were imaged using plain x-ray film) from September 5, 2005 to April 23, 2008. Abdominal-pelvic CT appearances (shape, size, number, location and density) and abdominal plain x-ray film manifestations were retrospectively observed for those who were finally confirmed as heroin body packers through the passing of evacuated drug packets. RESULTS Among 158 cases of suspected drug packers in our study, 124 cases were finally diagnosed as heroin body packers. This was consistent with the CT results. However, there were 2 false-negative cases of abdominal imaging taken with plain x-ray film. All of the evacuated heroin body packets were produced mechanically. CT and plain film characteristic findings included the presence of uniform shape, varied density, and well-defined round or ovoid intra-luminal foreign-body shadows arranged closely along the gastrointestinal (GI) tract and/or vagina. We also found that the "air-ring sign" and "onion sign" were valuable characteristics that were seen on the CT scan, which helped to positively confirm the detection of heroin packets. CONCLUSION Heroin body packing has clearly defined diagnostic features that can be seen with CT. Furthermore, conventional abdominal-pelvic CT is the imaging modality of choice in the evaluation of suspected body packers.
Collapse
|
23
|
|
24
|
Abstract
Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients.
Collapse
|
25
|
Guinier D, Hubert N, Chopard JL. [Surgical and forensic problems of body-packing]. JOURNAL DE CHIRURGIE 2007; 144:481-485. [PMID: 18235358 DOI: 10.1016/s0021-7697(07)79772-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Body-packing has increased as a means of illicit drug transportation, particularly since the intensification of customs control and luggage inspection which followed the terrorist attacks of September 11, 2001. This mode of drug transport may result in intestinal obstruction or systemic intoxication; diagnostic measures are discussed; management may require specific precautions and occasionally surgical intervention. The problem of how to handle and dispose of large quantities of drugs removed from or passed by a patient who may not be under arrest presents specific medicolegal considerations.
Collapse
Affiliation(s)
- D Guinier
- Service de Chirurgie Viscérale, Hôpital Louis-Pasteur, CHG - Dole.
| | | | | |
Collapse
|
26
|
Sengupta A, Page P. Window manipulation in diagnosis of body packing using computed tomography. Emerg Radiol 2007; 15:203-5. [PMID: 17713799 DOI: 10.1007/s10140-007-0652-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/22/2007] [Indexed: 11/25/2022]
Abstract
Body packing refers to the internal concealment of narcotics, usually within the gastrointestinal tract. This is important to recognise for clinical and forensic reasons. Imaging is often helpful, particularly because an accurate history is unusual. Furthermore, clinical examination and urine screens are often unreliable. Plain abdominal radiography and ultrasonography have been used with limited success. Thus, the use of alternative modalities, such as computed tomography (CT), is becoming more widespread. Although there have been no large trials, one false-negative has been reported. We report the case of a body packer whose CT appeared normal with standard abdominal windowing (level 40/width 400). However, on manipulation of the windowing (level -175/width 600), paraffin and heroin packages became conspicuous within the colon. We suggest that the simple step of reviewing images on wider than standard abdominal windows may be helpful in the detection of ingested illicit packages of fatty density within the bowel.
Collapse
Affiliation(s)
- Anshuman Sengupta
- Royal Infirmary of Edinburgh, 51, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | | |
Collapse
|
27
|
Taheri MS, Hassanian-Moghaddam H, Birang S, Hemadi H, Shahnazi M, Jalali AH, Shakiba M, Nahvi V. Swallowed opium packets: CT diagnosis. ACTA ACUST UNITED AC 2007; 33:262-6. [PMID: 17610106 DOI: 10.1007/s00261-007-9269-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study is to report our experience in diagnosis of the opium body packers with CT scan. MATERIALS AND METHODS For 12 cases who confessed to opium packet ingestion, we did an abdominal and pelvic CT scan without contrast and evaluated the presence, number and location of opium packets and also measured the density of packets in Hounsfield unit (HU). RESULTS Mean age of our cases was 28.2 +/- 5.9 years (ranging 17-35 years). Eleven (91.6%) patients were male and only one case was female. In all patients, the packets were visualized in gastrointestinal (GI) lumen by CT scan. The mean of minimum HU was 163.8 +/- 19.6 and its maximum was 205.3 +/- 32.8. We had mortality in an 18-year-old female due to opium overdose. CONCLUSION CT scan could be a suitable imaging modality in identifying opium packets, similar to that reported for cocaine and heroin.
Collapse
Affiliation(s)
- Morteza Sanei Taheri
- Radiology Department, Loghman Hakim Hospital, Shaheed Beheshti Medical University, Tehran, Iran.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
|