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Puntonet J, Gorgiard C, Soussy N, Soyer P, Dion E. Body packing, body stuffing and body pushing: Characteristics and pitfalls on low-dose CT. Clin Imaging 2021; 79:244-250. [PMID: 34139609 DOI: 10.1016/j.clinimag.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Because of availability and low radiation dose level, low dose computed tomography (CT) is now commonly used to identify illicit in corpore drug transportation. This review illustrates the most common CT findings of in corpore drug transportation and describes complications due to in corpore drug transportation, with a special emphasis on low dose CT. Major information such as number of packets, exact location and aspect of packets must be assessed. Radiologist must be aware of the imaging characteristics of "in corpore" illicit drug transportation, and should know situations that may alter drug smugglers management.
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Affiliation(s)
- Julien Puntonet
- Department of Radiology - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, F-75006 Paris, France.
| | - Charlotte Gorgiard
- Université de Paris, F-75006 Paris, France; Medicolegal Department - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, 75001 Paris, France
| | - Nicolas Soussy
- Université de Paris, F-75006 Paris, France; Medicolegal Department - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, 75001 Paris, France
| | - Philippe Soyer
- Université de Paris, F-75006 Paris, France; Department of Radiology- Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France
| | - Elisabeth Dion
- Department of Radiology - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, F-75006 Paris, France
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Abedzadeh AA, Iqbal SS, Al Bastaki U, Pierre-Jerome C. New packaging methods of body packers: Role of advanced imaging in their detection. A case study. Radiol Case Rep 2019; 14:627-633. [PMID: 30923589 PMCID: PMC6424096 DOI: 10.1016/j.radcr.2019.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 01/08/2023] Open
Abstract
Body packing is one of the common ways to traffic illicit drugs. Drug mules usually swallow or insert drugs within the gastrointestinal tract or other orifices. Detection of such drug packets has become difficult because of the constantly improving packaging techniques and the sophistication used by traffickers. Suspected obstruction or perforated hollow viscus requires employment of appropriate radiological procedures and techniques for accurate detection and precise diagnosis. A delay diagnosis and inappropriate action may carry disastrous physical consequences for the body packers. It is crucial for radiologists to acquire enough experience to deduce different types of drug packets from their imaging characteristics and to accurately guide emergency physicians and security officials. The packets are not always radiodense, therefore they can be difficult to detect on conventional abdominal radiographs. In this report, the authors illustrate 5 cases with different packaging methods and materials that give rise to radiological challenges.
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Affiliation(s)
- Ayoub Ahmad Abedzadeh
- Department of Radiology, Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai, United Arab Emirates
| | - Shaikh Sayeed Iqbal
- Department of Radiology, Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai, United Arab Emirates
| | - Usama Al Bastaki
- Department of Radiology, Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai, United Arab Emirates
| | - Claude Pierre-Jerome
- Department of Radiology, Ackershus University Hospital, Sykehusveien, 75, 1470 Oslo, Norway
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3
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Tsang HKP, Wong CKK, Wong OF, Chan WLW, Ma HM, Lit CHA. Radiological features of body packers: An experience from a regional accident and emergency department in close proximity to the Hong Kong International Airport. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918770083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Body packing is a frequently used method for drug trafficking. Local information about the clinical and radiological features of body packing is lacking. Objectives: To evaluate the radiological features of body packers presenting to a hospital near to the Hong Kong International Airport and to compare the radiological features of solid form versus liquid cocaine. Methods: This was a retrospective cohort study. Medical notes of 269 suspected body packers, presenting to the Accident and Emergency Department of North Lantau Hospital under the detention by the law enforcement personnel from 1st January 2015 to 28th February 2017, were reviewed. The radiological features of body packing were retrospectively evaluated. Results: Sixty-nine cases were confirmed body packers radiographically. Majority of them (81%, 56/69) were cocaine packers. Powder form cocaine (67%, 49/69) was the most popular drug packed, followed by liquid cocaine (15%, 10/69). There was a trend of increasing incidence of liquid cocaine packers. The classical ‘double condom’, ‘tic tac’ and ‘halo’ signs were present in 94%, 72.5% and 42% of cases with radiologically confirmed body packing respectively. The ‘rosette’ sign was only identified in 1 case. Three new radiological signs, the ‘bag of eggs’, ‘lucent triangle’ and ‘black crescent’ sign, were suggested to aid identification of drug packets. The classical ‘tic tac’ sign was absent in all liquid cocaine packing cases (p<0.05). The liquid cocaine packets appeared irregular with indistinct border in majority of cases (p<0.05). The solid form packets were mostly opaque to faeces while liquid cocaine had variable density (p<0.05). Most solid form packets had homogeneous content which was in contrast to the heterogeneous content in liquid cocaine (p<0.05). Conclusion: Failure in detecting drug body packing may result in medicolegal consequences. Emergency physicians need to be aware of subtle radiological signs of liquid cocaine packets in the plain abdominal radiography.
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Affiliation(s)
| | - Cheuk Kei Kathy Wong
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - Oi Fung Wong
- Accident and Emergency Department, North Lantau Hospital, Hong Kong
| | | | - Hing Man Ma
- Accident and Emergency Department, North Lantau Hospital, Hong Kong
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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]
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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.
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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
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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]
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Shahnazi M, Hassanian-Moghaddam H, Gachkar L, Ahmadi N, Zamani N, Bahrami-Motlagh H, Faghihi Langroudi T, Arjmand Shabestari A, Mohammad Alizadeh A. Comparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers. Clin Toxicol (Phila) 2015; 53:596-603. [PMID: 26065361 DOI: 10.3109/15563650.2015.1054501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT Toxicity due to body packing/pushing/stuffing is a major concern in many countries. Of different imaging techniques, computed tomography (CT) scan is described as the method of choice in detecting body couriers, but there is no study to concomitantly compare with- and without-contrast abdominopelvic CTs to determine the more accurate one for this purpose. OBJECTIVE We aimed to evaluate the efficacy of abdominopelvic CT "with" and "without" oral contrast in diagnosis of existence, number, and type of packets in body packers/pushers and stuffers. MATERIALS AND METHODS In a prospective observational case series, all suspected cases of body packing/stuffing were included and underwent abdominopelvic CT with and without oral contrast in a one-year period. CT scans were reported by three independent attending radiologists blind to the demographic and clinical results and compared to our defined "gold standard" which was surgery or expulsion of packets. The existence and number of packets detected by each method were compared to define the better method of diagnosis. RESULTS Of 11 suspect body packers/pushers, 10 carried packs. Abdominopelvic CT with and without oral contrast detected six and seven of them, respectively. In 24 body stuffers, CT without oral contrast was more accurate in diagnosis of existence (9/24 vs. 7/24, p = 0.003) and number (sensitivity and positive predictive values of 29.2% vs. 37.5% and 100% vs. 100% for CTs with and without oral contrast, respectively, p = 0.021). DISCUSSION AND CONCLUSIONS There is a remarkable gap between detection of existence and number of packets/baggies reported by the radiologists and the real condition of the patients. A close teamwork between radiologists and toxicologists is needed to manage these problematic cases.
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Affiliation(s)
- Makhtoom Shahnazi
- Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Scineces , Tehran , Iran
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Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT protocol as a diagnosis tool for body packers. Clin Radiol 2014; 69:e525-30. [DOI: 10.1016/j.crad.2014.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
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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.
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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.
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10
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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.
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Affiliation(s)
- Ferco H Berger
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands,
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11
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Grimm J, Wudy R, Ziegeler E, Wirth S, Uhl M, Reiser MF, Scherr M. Differentiation of heroin and cocaine using dual-energy CT—an experimental study. Int J Legal Med 2014; 128:475-82. [DOI: 10.1007/s00414-014-0980-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/13/2014] [Indexed: 01/08/2023]
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12
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Abdul Rashid SN, Mohamad Saini SB, Abdul Hamid S, Muhammad SJ, Mahmud R, Thali MJ, Flach PM. Walking on thin ice! Identifying methamphetamine "drug mules" on digital plain radiography. Br J Radiol 2014; 87:20130472. [PMID: 24472728 DOI: 10.1259/bjr.20130472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in "drug mules" by plain abdominal digital radiography (DR). METHODS The study consisted of 35 individuals suspected of internal MA drug containers. A total of 59 supine digital radiographs were collected. An overall calculation regarding the diagnostic accuracy for all "drug mules" and a specific evaluation concerning the radiological appearance of drug packs as well as the rate of clearance and complications in correlation with the reader's experience were performed. The gold standard was the presence of secured drug packs in the faeces. RESULTS There were 16 true-positive "drug mules" identified. DR of all drug carriers for Group 1 (forensic imaging experienced readers, n = 2) exhibited a sensitivity of 100%, a mean specificity of 76.3%, positive predictive value (PPV) of 78.5%, negative predictive value (NPV) of 100% and a mean accuracy 87.2%. Group 2 (inexperienced readers, n = 3) showed a lower sensitivity (93.7%), a mean specificity of 86%, a PPV of 86.5%, an NPV of 94.1% and a mean accuracy of 89.5%. The interrater agreement within Group 1 was 0.72 and within Group 2 averaged to 0.79, indicating a fair to very good agreement. CONCLUSION DR is a valuable screening tool in cases of MA body packers with huge internal payloads being associated with a high diagnostic insecurity. Diagnostic insecurity on plain films may be overcome by low-dose CT as a cross-sectional imaging modality and addressed by improved radiological education in reporting drug carriers on imaging. ADVANCES IN KNOWLEDGE Diagnostic signs (double-condom and halo signs) on digital plain radiography are specific in MA "drug mules", although DR is associated with high diagnostic insecurity and underreports the total internal payload.
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Affiliation(s)
- S N Abdul Rashid
- Department of Radiology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
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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.
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Affiliation(s)
- A Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
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14
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Bulakci M, Ozbakir B, Kiris A. Detection of body packing by magnetic resonance imaging: a new diagnostic tool? ACTA ACUST UNITED AC 2014; 38:436-41. [PMID: 23223858 DOI: 10.1007/s00261-012-9972-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE In this study, we aimed to describe non-contrast abdominal MRI findings in body packers and emphasize the role of this imaging technique in diagnosis of body packing. MATERIALS AND METHODS Non-contrast abdominopelvic MRI was performed at the radiology department in 16 suspected body packers that were brought to our hospital, and 13 of them were diagnosed with body packing. We evaluated the presence, location, and shapes of packets as well as signal characteristics on T1- and T2-weighted images. RESULTS We came across two types of packets: those containing solid substances (10 cases) and those filled with liquid cocaine (3 cases). Both types were accurately diagnosed with the help of MRI. Only 1 suspected body packer received a false positive diagnosis. CONCLUSION Abdominopelvic MRI is a reliable and valuable method of diagnosing body packing.
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Affiliation(s)
- Mesut Bulakci
- Department of Radiology, Haseki Training and Research Hospital, Aksaray, Istanbul, Turkey.
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Flach PM, Ross SG, Ebert LC, Thali MJ, Ampanozi G. Response to "the detection of internal cocaine drug packs: a radiological challenge in the future?". Eur J Radiol 2013; 82:1588-90. [PMID: 23726125 DOI: 10.1016/j.ejrad.2013.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ab Hamid S, Abd Rashid SN, Mohd Saini S. Characteristic imaging features of body packers: a pictorial essay. Jpn J Radiol 2012; 30:386-92. [PMID: 22415809 DOI: 10.1007/s11604-012-0069-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/26/2012] [Indexed: 11/26/2022]
Abstract
The drug-trafficking business has risen tremendously because of the current increased demand for illegal narcotics. The smugglers conceal the drugs in their bodies (body packers) in order to bypass the tight security at international borders. A suspected body packer will normally be sent to the hospital for imaging investigations to confirm the presence of drugs in the body. Radiologists, therefore, need to be familiar with and able to identify drug packets within the human body because they shoulder the legal responsibilities. This pictorial essay describes the characteristic imaging features of drug packets within the gastrointestinal tract.
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Affiliation(s)
- Suzana Ab Hamid
- Department of Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43100 Serdang, Selangor, Malaysia.
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17
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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.
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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
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18
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Beauverd Y, Poletti PA, Wolff H, Ris F, Dumonceau JM, Elger BS. A body-packer with a cocaine bag stuck in the stomach. World J Radiol 2011; 3:155-8. [PMID: 21860710 PMCID: PMC3158883 DOI: 10.4329/wjr.v3.i6.155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 03/02/2011] [Accepted: 03/09/2011] [Indexed: 02/06/2023] Open
Abstract
Management of patients carrying packets of drugs in the digestive tract is a frequent medical problem. We report on a patient who was referred by the police after ingestion of packets of cocaine. After spontaneous elimination of 81 drug packets, the patient had three unremarkable stools. A plain abdominal X-ray disclosed no residual packet but computed tomography (CT) scan showed one in the stomach. As this was not eliminated during the 10 d following ingestion, it was removed through gastrotomy. This case stresses the usefulness of the CT scan to ensure that no residual packet is present before hospital discharge.
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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]
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Baljevic M, Sadiq ND, Hussain N. “Body Packing” and its Implications in Qatar. Qatar Med J 2008. [DOI: 10.5339/qmj.2008.2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The internal concealment of highly profitable illicit drugs such as cocaine and heroin, by means of body packing is an important means of international drug trafficking. This phenomenon is apparently uncommon in Qatar, with only one reported case thus far. Here, we present a case of body packer who was transiting Doha and was found to be carrying 90 internalized packets of heroin. Regardless of whether this is another isolated case or an emerging phenomenon in Qatar, awareness of medical and surgical complication that can arise in these individuals is of importance to practicing physicians.
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Affiliation(s)
- M. Baljevic
- *Weill Cornell Medical College in Qatar, Qatar Foundation, Education City
| | - N. D. Sadiq
- **Cardiology Department of Medicine, Hamad Medical Corporation Doha, Qatar
| | - N. Hussain
- *Weill Cornell Medical College in Qatar, Qatar Foundation, Education City
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Hahn IH, Hoffman RS, Nelson LS. Contrast CT scan fails to detect the last heroin packet. J Emerg Med 2005; 27:279-83. [PMID: 15388217 DOI: 10.1016/j.jemermed.2004.04.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2002] [Revised: 04/13/2004] [Accepted: 04/30/2004] [Indexed: 10/26/2022]
Abstract
We report on the comparative utility of the abdominal computed tomography (CT) scan and contrast-enhanced plain radiography in one case of a "body packer" who claimed to have passed 50 out of 55 packets before being brought to the Emergency Department by the police for further gastrointestinal decontamination. The presence of retained packets was confirmed by plain radiography. The patient received whole bowel irrigation (WBI) with polyethylene glycol electrolyte solution (PEG-ELS) and passed four more packets. A helical abdominal CT scan with oral contrast was performed to identify any residual packets. A negative CT scan and a reliable patient prompted a subsequent upright abdominal radiograph that showed the last packet in the right lower quadrant. This packet ultimately passed with continued WBI. This case illustrates the failure of CT scan to identify the last packet and suggests that multiple modalities may be necessary to fully confirm a therapeutic endpoint.
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Affiliation(s)
- In-Hei Hahn
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York 10019, USA
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22
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Affiliation(s)
- Stephen J Traub
- Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, USA.
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23
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Olmedo R, Nelson L, Chu J, Hoffman RS. Is surgical decontamination definitive treatment of "body-packers"? Am J Emerg Med 2001; 19:593-6. [PMID: 11699007 DOI: 10.1053/ajem.2001.21720] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The current recommendations for body-packers are based on packet content, the presence of drug toxicity, or of bowel obstruction. Asymptomatic patients are usually treated with activated charcoal and whole bowel irrigation (WBI). Surgical removal of packets is advocated in symptomatic cocaine body-packers and in those with bowel obstruction. Currently, surgery is regarded as definitive. However, we report 2 body-packers who show the limitations of this technique. These cases show the importance of confirming the absence of drug packets in the gastrointestinal (GI) tract as the definitive end-point in the treatment of body-packers.
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Affiliation(s)
- R Olmedo
- Division of Toxicology, Department of Emergency Medicine, Mount Sinai School of Medicine, The Mount Sinai Medical Center, The Mount Sinai Hospital, New York, NY 10029-6574, USA
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24
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Hierholzer J, Cordes M, Tantow H, Keske U, Mäurer J, Felix R. Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound. ABDOMINAL IMAGING 1995; 20:333-8. [PMID: 7549738 DOI: 10.1007/bf00203366] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the imaging characteristics and the diagnostic value of both abdominal ultrasound and conventional abdominal x-ray in identifying ingested drug packages in "body packers." MATERIALS AND METHODS Twelve individuals were studied prospectively by abdominal ultrasound and by abdominal x-ray to rule out incorporated drug containers. RESULTS Both abdominal ultrasound and abdominal x-ray correctly identified the 7 of 12 individuals who had ingested multiple drug packages. In 5 of the 12 individuals, ultrasound as well as abdominal x-ray were correctly unremarkable with regard to abdominal foreign bodies. CONCLUSIONS Abdominal ultrasound and abdominal x-ray both represent valuable diagnostic tools in the assessment of ingested drug packages. Abdominal x-ray is superior to ultrasound in differentiating ingested drug-filled condoms from "pseudocondoms."
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Affiliation(s)
- J Hierholzer
- Strahlenklinik und Poliklinik, Virchow-Klinikum, Medizinische Fakultätder Humboldt-Universität zu Berlin, Germany
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25
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Wehr K, Alzen G. [Perfected, professional body-packing]. ZEITSCHRIFT FUR RECHTSMEDIZIN. JOURNAL OF LEGAL MEDICINE 1989; 103:63-8. [PMID: 2588820 DOI: 10.1007/bf01255848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 27-year-old Columbian male was arrested in Aix la Chapelle at the border to Belgium, as he was suspected, of smuggling drugs in his body. Ultrasonographic and radiographic examinations revealed numerous packets in the colon descendens and the ampulla recti. After administration of laxatives, 70 packets were excreted that had been swallowed 3 days before in Bogota, Columbia. Each packet consisted of two rubber bags that were separately knotted with cord, layers of plastic foil, two further knotted rubber bags; the pressed core of cocaine was an average 3.8 cm in length, 1.9 cm in diameter, and 10.2 g in weight. The cocaine hydrochloride content ranged from 75.7% to 100%, with an average of 81.9%. The total net weight came to 714 g. Urine analysis revealed no cocaine metabolites, but metamizole and metamizole metabolites were present as a result of administration of Buscopan compositum during the flight to prevent premature excretion of the packets.
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Affiliation(s)
- K Wehr
- Institut für Rechtsmedizin, Medizinische Fakultät der Rheinisch-Westfälischen Technischen Hochschule Aachen, Bundesrepublik Deutschland
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26
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Hartoko TJ, Demey HE, De Schepper AM, Beaucourt LE, Bossaert LL. The body packer syndrome--cocaine smuggling in the gastro-intestinal tract. KLINISCHE WOCHENSCHRIFT 1988; 66:1116-20. [PMID: 3236761 DOI: 10.1007/bf01727846] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cocaine drug packets were found in the gastro-intestinal tract of seven persons, charged with and arrested for presumed drug smuggling. Plain abdominal roentgenograms were positive in 4, while computer tomography of the abdomen (CT-scan) was necessary in 3 others to make the diagnosis. There were no signs of acute intoxication or bowel obstruction. All patients were treated with enemas and/or laxatives in order to evacuate the hidden packets; no complications occurred. A clinical description of the seven cases is followed by a short review of the literature, mainly focused on the possible complications of ingested drug packets and possible methods of removal.
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Affiliation(s)
- T J Hartoko
- Department of Intensive Care, University of Antwerp - University Hospital, Edegem, Belgium
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