Is abdominal x-ray (AXR) or computed tomography (CT) of the abdomen the most appropriate imaging modality for the detection of illegal substances concealed, taking into consideration the sensitivity, specificity and radiation dose?

Gastric Obstruction by Opium Packets: A Case Report

BACKGROUND

We reported a case of gastric obstruction in a body packer who swallowed a large number of opium packets.

CASE REPORT

A 36-year-old man opium addict visited the emergency department with epigastric pain for three days. He swallowed nearly 90 packets of opium for smuggling purposes four days earlier. He self-administered laxatives. In contrast, many times vomiting, he defecated only four packets and vomited one packet. The abdominal X-rays showed some amounts of fluid-air levels and multiple cylindrical opacities with the double-condom sign, corresponding to the distended stomach. Due to the worsening of his abdominal symptoms, he underwent an urgent laparotomy and 84 packets (4-6 cm in size and 8-10 g/ packet of opium) with a total weight of 870 g. They were wrapped in some layers of plastic and tied at the ends. He was discharged in stable condition.

CONCLUSION

A large number of ingested drug packets can induce gastrointestinal obstruction.

Using CT scout view to scan illicit drug carriers may reduce radiation exposure

OBJECTIVE

The aim of this study was to present our experience on the evaluation of suspected illicit drug carriers via computerized tomography scout view (CTSV) with analysis of detectability and features such as content, form and density.

METHODS

A total of 120 individuals suspected of body packing were screened via CT in a university emergency department between January 2014 and December 2017.

RESULTS

88.3% of 120 body packing cases examined in the study were male. The median (1st quartile-3rd quartile) age of the cases was 35.5 (30-41) years. We found that solid packs have a 4.573-fold higher likelihood of detection in CTSV screening than liquid ones (95%CI: 1.879-11.134). Additionally, the number of CT scans needed were significantly associated with capsule localization (stomach) (OR:7.178, 95%CI: 2.420-21.293) and solid form packs (OR: 8.705, 95%CI: 2.318-32.692) are associated with number of CT scans.

CONCLUSION

CTSVs have a successful detection rate, especially in solid form packs. Our results suggest that conclusive CTSV imaging for body packing may be recommended to delay the application of the next CT scan until the passage of the first capsule; thereby preventing unnecessary radiation exposure.