Assessing the Epidemiological Data and Management Methods of Body Packers Admitted to a Referral Center in Iran

Bowel obstruction in body-packing: A case report and literature review

INTRODUCTION AND IMPORTANCE

The body packer swallows or embeds drugs in body cavities in a purposeful way. Packets usually contain of opium, cocaine, cannabis and amphetamines. The significant complications of body packing usually are symptoms of drug toxicity due to leaking or ruptured packets or symptoms of ingesting relatively large foreign bodies. Herein, we present a case of heroin body-packing that resulted in subsequent bowel obstruction.

CASE PRESENTATION

A 30-year-old male, who was brought from the prison to the emergency department, complained of abdominal pain. After the absence of intoxication symptoms and insignificant plain abdominal radiograph results, abdominal computed tomography (CT) scan revealed the presence of ingested packets in the stomach as well as in the patient's small intestine. Therefore, the decision of surgery was immediately made for the patient, and during the surgery, the drug packets were entirely removed. The patient was discharged in good general condition three days after his surgery.

CLINICAL DISCUSSION

Body packers are in considerable risk as rupture of packet inside the body and risk of obstruction that both of them may be fatal. Patients should be monitored for complications, possible early treatment, and removal or assistance in expulsion drug packets from the body. Initially on plain abdominal radiographs, classic findings suggest the presence of drug packets.

CONCLUSION

In case of an inconclusive plain abdominal radiograph, further investigation with CT is indicated, with an almost 100 % sensitivity. For symptomatic patients, bowel obstruction and acute drug toxicity are the two most common indications for surgical intervention.

International Smuggling of Illicit Drugs by Body Concealment at a Tertiary Hospital in Istanbul

ABSTRACT

Smuggling of illicit substances by internal concealment has recently become a preferred method of international drug trade. The drug carriers are known as body packers. This study aimed to assess the demographic features and outcomes of body packers admitted to a referral center in Istanbul. Data were retrospectively evaluated from January 2017 to December 2019 from suspected body packers who were referred to the emergency department of a tertiary-care university by Istanbul Airport narcotics police due to suspected concealment of illicit drugs. Eighty-one cases were identified and included in this study. Of these, 71 subjects were confirmed to be body packers by radiological methods. The 15 women and 56 men had a mean age of 35 years. The most common nationality of the body packers was Nigerian, followed by Turkish and South African. Cocaine was the most commonly smuggled packet, followed by hashish, and heroin. All body packers were conservatively managed using laxatives or watchful waiting. No cases required surgical retrieval of packets. Abdominal radiography and computed tomography are useful tools for the evaluation of suspected body packers. The use of improved packaging material by smugglers and complications due to surgery and endoscopy make the conservative approach preferred.

A patient full of surprises: a body packer with cocaine intoxication, pneumococcal pneumonia and HIV infection

BACKGROUND

Smuggling of illegal drugs by hiding them inside one's own body, also called body packing, is a worldwide phenomenon. Cocaine is the most frequently transported drug. Body packing is a potentially lethal practice. The most serious complications of body packing are gastrointestinal obstruction or perforation and drug toxicity due to packet leakage or rupture.

CASE PRESENTATION

A 30-year-old confirmed body packer was brought to our emergency department from jail because of agitation and mydriasis. He presented with a high respiratory rate of 40/min but normal oxygen saturation on ambient air, a heart rate of 116 bpm, a blood pressure of 116/68 mmHg and a temperature of 38.0° Celsius. Blood tests were suggestive of infection, urine analysis was positive for cocaine. Abdominal and thoracic computed tomography scans showed pulmonary infiltrates as a possible focus of infection; signs of bowel obstruction or perforation were absent. Given his clinical presentation, we suspected severe infection rather than massive cocaine intoxication to be the main problem. We therefore withheld immediate surgical decontamination. Instead, we started broad-spectrum antibiotic treatment with piperacillin/tazobactam plus clarithromycin for suspected severe community-acquired pneumonia or abdominal sepsis and treated the patient with intravenous midazolam for symptomatic cocaine intoxication. After detection of urinary pneumococcal antigen, the antibacterial regimen was changed to ceftriaxone and vancomycin for pneumococcal pneumonia. In addition, we found human immunodeficiency virus (HIV) type 1 infection as underlying disease. The patient recovered from his acute illness and was discharged after 7 days of treatment with ceftriaxone plus vancomycin. Antiretroviral therapy was started in an outpatient setting.

CONCLUSIONS

With this case report, we emphasize the need to look for alternative diagnoses to intoxication and gastrointestinal obstruction in acutely ill body packers with atypical presentation. Special risks, such as underlying HIV infection and potential antimicrobial resistance according to the individual's geographical origin, should be taken into account while treating these patients.

H. Prise en charge des body-packers

>Aujourd’hui, le body-packing ou transport in corpore de substances illicites est le mode de transport de drogues le plus répandu en Europe. Il porte essentiellement sur la cocaïne et l’héroïne, bien que toute autre substance puisse être concernée dans une moindre mesure. Les passeurs (« mules ») sont identifiés par les services de police et de douane sur la base de plusieurs indices permettant de les suspecter, comme l’origine des vols long-courriers, l’abstinence alimentaire, etc. La sensibilité du dépistage urinaire et le diagnostic reposent essentiellement sur l’imagerie abdominale, de préférence l’examen tomodensitométrique lorsqu’il est disponible. Les passeurs sont ensuite placés sous surveillance médicale. Celle-ci n’est pas standardisée, mais devrait durer au moins six heures, avec une attention particulière aux paramètres hémodynamiques et neurologiques. Le risque de rupture des paquets est principalement lié à la qualité de l’emballage. Le traitement est essentiellement conservateur. Les complications restent rares, et le recours à la chirurgie s’avère nécessaire en cas de signes d’intoxication et/ou d’occlusion digestive.