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Wu P, Lui SNS, Lee HHC, Wong OF. An unexpected computed tomography finding in a suspected body packer. Clin Toxicol (Phila) 2024:1-2. [PMID: 39225236 DOI: 10.1080/15563650.2024.2395547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Computed tomography can be used to screen and diagnose the presence of drug-filled packets in the body. We present an unusual computed tomography finding in a suspected body packer. CASE SUMMARY A traveller suspected of being a body packer was brought to the emergency department complaining of low back pain. On examination, there was an abdominal cast circumferentially encasing his abdomen, which he alleged was part of the management of his lower back pain in his own country. IMAGES A plain computed tomogram of the abdomen and pelvis revealed that the cast was made of materials with a nodular appearance and heterogeneous density, which was different from that of a plaster of Paris cast. An investigation later confirmed the cast contained cocaine. CONCLUSION Our case demonstrates how a body packer can traffic drugs outside their body for an alleged medical reason.
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Affiliation(s)
- Ping Wu
- Intensive Care Unit, Tuen Mun Hospital, Hong Kong
| | | | | | - Oi Fung Wong
- Acute and Emergency Department, North Lantau Hospital, Lantau, Hong Kong
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2
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Rungta N, Ray B, Bhalla A, Samaddar DP, Paul G, Prasad S, Dongre A, Kumar P, Gautam PL, Mishra A, Tyagi RS. Indian Society of Critical Care Medicine Position Statement: Approach to a Patient with Poisoning in the Emergency Room and Intensive Care Unit. Indian J Crit Care Med 2024; 28:S217-S232. [PMID: 39234227 PMCID: PMC11369925 DOI: 10.5005/jp-journals-10071-24697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 09/06/2024] Open
Abstract
Poisoning and its aftermath are globally observed and acknowledged concerns. India has a large burden of "self-harm/suicides" with 12.4/per 100,000 population committing suicide. Consumption of poisonous substances is the second most common mode of self-harm in India. Patients present to both public and private institutions in a critically ill state. The Indian Society of Critical Care Medicine (ISCCM) and Indian College of Critical Care Medicine (ICCCM) decided to address common and contentious issues related to poisoning by developing a position statement that is expected to be appropriate in the Indian scenario by the constitution of an "expert group" to provide a "set of statements" aimed at addressing the common issues faced by intensivists in their practice in managing such patients. The structured approach, framework, and process adopted in developing the position statement on the approach to poisoning have been detailed in this statement. The formation of an expert advisory panel was followed by a literature search, and multiple sessions of consensus-building exercises to reach the current statement presented below. The statement consists of relevant questions with possible answers thereof. Each answer was further weighed against the data and evidence available in the literature. Recommendations were made using a simplified score to make the statement qualitatively meaningful. How to cite this article Rungta N, Ray B, Bhalla A, DP Samaddar, Paul G, Prasad S, et al. Indian Society of Critical Care Medicine Position Statement: Approach to a Patient with Poisoning in the Emergency Room and Intensive Care Unit. Indian J Crit Care Med 2024;28(S2):S217-S232.
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Affiliation(s)
| | - Banambar Ray
- Department of Critical Care Medicine, Sum Ultimate Medicare a Unit of SOA, Bhubaneswar, Odisha, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - DP Samaddar
- Medical Affairs, Critical Care Unit, Academic and Quality Control, Ruby General Hospital, Kolkata, West Bengal, India
| | - Gunchan Paul
- Department of Critical Care Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Sayi Prasad
- Department of Critical Care Medicine, Diamond Super Specialty Hospital, Kolhapur, Maharashtra, India
| | - Anand Dongre
- Department of Intensive Care, Treat Me Multispecialty Hospital, Nagpur, Maharashtra, India
| | - Prashant Kumar
- Department of Anesthesia and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Parshottam L Gautam
- Department of Critical Care Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Anand Mishra
- Department of Critical Care Medicine, Sum Ultimate Medicare a Unit of SOA, Bhubaneswar, Odisha, India
| | - Ranvir S Tyagi
- Department of Anesthesia and Critical Care, Synergy Plus Hospital and Galaxy Hospital, Agra, Uttar Pradesh, India
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Honar BN, Mollaverdi G, Aghajanian S, Bagherpour JZ. Bowel obstruction in body-packing: A case report and literature review. Int J Surg Case Rep 2023; 109:108503. [PMID: 37481974 PMCID: PMC10369466 DOI: 10.1016/j.ijscr.2023.108503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Sepehr Aghajanian
- School of Medicine, Alborz University of Medical Sciences, Alborz, Iran; Neuroscience Research Center, Iran University of Medical Sciences, Iran
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4
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Boucher AL, Shah N, Brynien DH, Bregg JM, Yokota S. An unusual case of small bowel obstruction because of body packing. J Surg Case Rep 2023; 2023:rjad207. [PMID: 37124572 PMCID: PMC10131099 DOI: 10.1093/jscr/rjad207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
Body packing is the internal concealment of illicit drugs for the purpose of transportation and evasion of law enforcement. It is associated with medical complications such as acute toxicity from ingested drug, bowel obstruction or perforation. It is rare to require surgical intervention with a small amount of ingested drug packet. Here, we present the case of a young adult male who presented with abdominal pain for 3 days. The patient admitted ingesting a condom filled with suboxone several years ago and denied recent ingestion. The patient was found to have small bowel obstruction with ingested foreign body being a transition point on CT scan, requiring exploratory laparotomy and small bowel resection.
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Affiliation(s)
| | - Nikunj Shah
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Daniel H Brynien
- Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Jason M Bregg
- Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Shinichiro Yokota
- Correspondence address. 320 E North Avenue, Suite 556, Pittsburgh, PA 15212, USA. Tel: 412-359-6907; Fax: 412-359-3212; E-mail:
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Kaplan O, Sogut O. International Smuggling of Illicit Drugs by Body Concealment at a Tertiary Hospital in Istanbul. Am J Forensic Med Pathol 2023; 44:25-32. [PMID: 36194669 DOI: 10.1097/paf.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Onur Kaplan
- From the Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Can TS, Yilmaz BK, Ozdemir S. Using CT scout view to scan illicit drug carriers may reduce radiation exposure. J Forensic Leg Med 2021; 81:102202. [PMID: 34153884 DOI: 10.1016/j.jflm.2021.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Tuba Selcuk Can
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey.
| | - Behice Kaniye Yilmaz
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sevim Ozdemir
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
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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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8
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Mathew RP, Sarasamma S, Jose M, Toms A, Jayaram V, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1. SA J Radiol 2021; 25:2022. [PMID: 33936794 PMCID: PMC8063768 DOI: 10.4102/sajr.v25i1.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Sreekutty Sarasamma
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Merin Jose
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Ajith Toms
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vinayak Jayaram
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
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9
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Imaging of drug mules. Emerg Radiol 2021; 28:809-814. [PMID: 33738658 DOI: 10.1007/s10140-021-01924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Cocaine, heroin, methamphetamine, and hashish are the primary drugs transported by a body packer, who swallows such packages. A body pusher or stuffer transports drug packages in rectum or vagina. Plain radiography is the primary imaging modality used in the evaluation of concealed drugs and has sensitivity of 85-90%. The imaging features include well-defined opacities in the bowel with crescents of air near ovoid opacities. The imaging signs include double condom sign, halo sign, parallelism sign, and tic tac sign. A low-dose CT is an efficient noninvasive and accurate technique of locating packages internally for all types of concealment.
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10
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Ruoyang T, Tianji C. Smuggling of drugs by body packing: Evidence from Chinese sentencing documents. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103022. [PMID: 33358261 DOI: 10.1016/j.drugpo.2020.103022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006-2016. METHODOLOGY This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers. RESULTS We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking -Yunnan, Sichuan, and Myanmar- and three potential authorities- Guangdong, Xinjiang, and Sichuan-which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment. CONCLUSION By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.
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Affiliation(s)
- Tang Ruoyang
- Department of Sociology, University of Macau, Macau, China
| | - Cai Tianji
- Department of Sociology, University of Macau, Macau, China.
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11
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A fatal case of cannabis body-packing: About an autopsy case report. J Forensic Leg Med 2020; 74:102033. [PMID: 32769041 DOI: 10.1016/j.jflm.2020.102033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/25/2020] [Indexed: 11/23/2022]
Abstract
The body packing represents an illegal drug trafficking practice across the borders of certain countries. It has experienced enormous growth in recent years. The medical literature is rich in publications interested in body packaging of cocaine or heroin with sometimes lethal consequences. However, reported cases of cannabis body packing appear to be rare, sometimes underestimated, despite the notoriety of cannabis in the illegal drug market and its wide consumption around the world. We report in this work a forensic case of a cannabis body packer deceased due toa stercoral peritonitis secondary to a double perforation of thesigmoid and rectal colon.
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12
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Tang R, Cai T. Smuggling of drugs by body packing: Evidence from Chinese sentencing documents. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102732. [PMID: 32213456 DOI: 10.1016/j.drugpo.2020.102732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006-2016. METHODOLOGY This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers. RESULTS We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking -Yunnan, Sichuan, and Myanmar- and three potential authorities- Guangdong, Xinjiang, and Sichuan-which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment. CONCLUSION By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.
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Affiliation(s)
- Ruoyang Tang
- Department of Sociology, University of Macau, Avenida da Universidade Taipa, Macau, China
| | - Tianji Cai
- Department of Sociology, University of Macau, Avenida da Universidade Taipa, Macau, China.
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13
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A Curious Case of the Persistent Body Stuffer. Case Rep Emerg Med 2019; 2019:3948054. [PMID: 31637063 PMCID: PMC6766140 DOI: 10.1155/2019/3948054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/31/2019] [Indexed: 02/07/2023] Open
Abstract
A 29-year-old male presented to our emergency department with complaint of abdominal pain after allegedly ingesting a 4-gram packet of heroin in an attempt to evade detection. Initial evaluation including computed tomography (CT) of the abdomen/pelvis with intravenous and oral contrast, as well as laboratory workup was negative and the patient was discharged. The patient returned 3 days later with complaint of "I feel high" and severe constipation, and demonstrated an opiate toxidrome requiring naloxone with improvement of symptoms. A repeat CT of the abdomen/pelvis, this time without contrast revealed a 2.1 × 1.8 cm foreign body in the gastric antrum. The patient was promptly taken to endoscopy with surgical backup. Foreign body removal included multiple plastic bags encasing heroin, which had sustained a small leak causing a gastric outlet obstruction as well as a slow opiate toxidrome. The foreign body was removed and the patient was observed and discharged with a favorable outcome.
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14
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Management recommendations for body stuffers at emergency units. Arh Hig Rada Toksikol 2019; 70:90-96. [PMID: 31246574 DOI: 10.2478/aiht-2019-70-3199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 05/01/2019] [Indexed: 01/08/2023] Open
Abstract
Managing body packers and stuffers is a challenge to emergency physicians, stuffers in particular, as there is no systematic approach to their treatment. The aim of this study was therefore to review all available literature on body stuffing and propose a guide to manage these patients. We searched Medline/PubMed, Google Scholar, and Scopus for published work on body stuffers using key words "body stuffer", "body stuffing", "poisoning", "toxicity", and "treatment" without a time limit and retrieved 290 articles, of which 61 remained after exclusion of those on "body packers" and repetitive documents. This review article evaluates and summarises the information gathered from them. The main step in body stuffer management is observation to make sure that they have passed all the swallowed packages of drugs of abuse. In some cases, imaging can be quite useful. Diagnostic pitfalls may be avoided with abdominopelvic CT without contrast, which is probably the best diagnostic method to determine the presence and the number of packages in these patients. Treatment should be specific for each group of drugs, whether it is opioids, cocaine, or amphetamine. Surgical interventions are indicated for obstruction of the intestines or package rupture. Legal precautions should be taken because of the legal complexity of body stuffing cases.
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15
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Agrawal A, Usenko A, Wong P, Tsegaye A, Narasimhan M. The Curious Case of a 55-Year-Old Man With New-Onset Seizures. Chest 2019; 152:e29-e32. [PMID: 28797397 DOI: 10.1016/j.chest.2017.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY.
| | - Aleksey Usenko
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY
| | - Patrick Wong
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY
| | - Adey Tsegaye
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY
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16
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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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17
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Lan K, Doyle E. 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? ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jofri.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Lo Re G, Salerno S, Terranova MC, Argo A, Casto AL, Zerbo S, Lagalla R. Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging. Semin Ultrasound CT MR 2019; 40:67-78. [PMID: 30686370 DOI: 10.1053/j.sult.2018.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass disasters.
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Affiliation(s)
- Giuseppe Lo Re
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy
| | - Sergio Salerno
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy
| | - Maria Chiara Terranova
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy.
| | - Antonella Argo
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy
| | - Antonio Lo Casto
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy
| | - Stefania Zerbo
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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20
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Schmit G, Abdallah FB, Vanhaebost J, P. H. Prise en charge des body-packers. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
>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.
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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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Wankhade VK, Chikhalkar B. Body packing and intra-vaginal body pushing of cocaine: A case report. Leg Med (Tokyo) 2018; 31:10-13. [DOI: 10.1016/j.legalmed.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/05/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
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23
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Pinto A, Berritto D, Russo A, Riccitiello F, Caruso M, Belfiore MP, Papapietro VR, Carotti M, Pinto F, Giovagnoni A, Romano L, Grassi R. Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:111-123. [PMID: 29350641 PMCID: PMC6179080 DOI: 10.23750/abm.v89i1-s.7015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
Radiography remains the imaging standard for fracture detection after trauma. The radiographic diagnosis of most fractures and dislocations poses little difficulty to radiologists: however, occasionally these injuries are quite subtle or even impossible to detect on radiographs. Missed diagnoses of fracture potentially have important consequences for patients, clinicians, and radiologists. Radiologists play a pivot role in the diagnostic assessment of the trauma patients: emergency radiologists who are more practiced at seeking out and discerning traumatic fractures can provide an invaluable service to their clinical colleagues by ensuring that patients do not endure delayed diagnoses. This is a narrative review article aims to highlight the spectrum of fractures in adults potentially missed on plain radiographs, the causes of error in diagnosis of fractures in the emergency setting and the key elements to reduce misdiagnosis of fractures.
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Nocerino EA, Cucchi D, Arrigoni P, Brioschi M, Fusi C, Genovese EA, Messina C, Randelli P, Masciocchi C, Aliprandi A. Acute and overuse elbow trauma: radio-orthopaedics overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:124-137. [PMID: 29350642 PMCID: PMC6179073 DOI: 10.23750/abm.v89i1-s.7016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them.
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25
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Michelini G, Corridore A, Torlone S, Bruno F, Marsecano C, Capasso R, Caranci F, Barile A, Masciocchi C, Splendiani A. Dynamic MRI in the evaluation of the spine: state of the art. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:89-101. [PMID: 29350639 PMCID: PMC6179074 DOI: 10.23750/abm.v89i1-s.7012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Degenerative disease of the spine is a generic term encompassing a wide range of different disease processes, which leads to spinal instability; traumatic/neoplastic events can accelerate this aging process. Therefore, the dynamic nature of the spine and its mobility across multiple segments is difficult to depict with any single imaging modality. METHODS A review of PubMed databases for articles published about kMRI in patients with cervical and lumbar spinal desease was performed. We focused on the physiopathological changes in the transition from supine to upright position in spine instability. DISCUSSION Until a few years ago, X-ray was the only imaging modality for the spine in the upright position. Of the imaging techniques currently available, MRI provides the greatest range of information and the most accurate delineation of soft-tissue and osseous structures. Conventional MRI examinations of the spine usually are performed in supine position, in functional rest, but the lumbar spine instability is often shown only by upright standing. This can result in negative findings, even in the presence of symptoms. Regardless, the final result is distorted. To overcome this limitation, Kinetic MRI (kMRI) can image patients in a weight-bearing position and in flexed and extended positions, thus revealing abnormalities that are missed by traditional MRI studies. CONCLUSION Despite some limitations, the upright MRI can be a complementary investigation to the traditional methods when there are negative results in conventional MRI in symptomatic patients or when surgical therapy is scheduled.
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26
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De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E, Piccolo C, Capasso R, Sica A, Cioce F, Carbone M, Bruno F, Masciocchi C, Miele V. Radiofrequency ablation of osteoid osteoma. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:175-185. [PMID: 29350646 PMCID: PMC6179079 DOI: 10.23750/abm.v89i1-s.7021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/24/2023]
Abstract
Osteoid osteoma is a benign bone neoplasm with a reported incidence of 2-3% among all bone primary tumors. Although it is a small and benign lesion, it is often cause of patient complaint and discomfort. It is generally characterized by a long lasting, unremitting pain that typically exacerbates at night, often leading to sleep deprivation and functional limitation of the skeletal segment involved, with a significant reduction of patient daily life activities and consequent worsening of the overall quality of life. Over decades, complete surgical resection has represented the only curative treatment for symptomatic patients. In the last years, new percutaneous ablation techniques, especially radiofrequency ablation, have been reported to be a safe and effective alternative to classical surgery, with a low complication and recurrence rate, and a significant reduction in hospitalization cost and duration. The aim of this article is to provide an overview about the radiofrequency thermal ablation procedure in the treatment of osteoid osteoma. (www.actabiomedica.it)
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27
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Vats M, Ramasamy S, Neogi S, Tudu SK. Ingestion of nine metallic nails with corrosive: what happened next? BMJ Case Rep 2017; 2017:bcr-2017-222338. [PMID: 29167219 DOI: 10.1136/bcr-2017-222338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 20-year-old woman was brought to the surgery emergency department with the complaint of epigastric pain since 1 day following ingestion of multiple metallic nails with a cup full of toilet cleaner (corrosive acid) with a suicidal intention. Physical examination was essentially unremarkable, and the abdomen showed no signs of perforation peritonitis. X-rays of the abdomen showed multiple 'nail'-like radiopaque shadows in the abdominal cavity with no evidence of free gas under the domes of the diaphragm. A non-operative expectant management was pursued. The patient had passed all the sharps in stools without any complication and was discharged after 12 days. After 3 weeks, the patient presented with non-bilious vomiting. Further investigations revealed pyloric stenosis with no oesophageal luminal stenosis. To bypass the pyloric stenosis, a Billroth II gastrojejunostomy was performed. The postoperative period was uneventful, and the recovery was smooth.
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Affiliation(s)
- Manu Vats
- General Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Sushanto Neogi
- General Surgery, Maulana Azad Medical College, New Delhi, India
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28
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Rodrigues FG, Campos JB, Silva GDA, Wexner SD. Endoscopic ultrasound in the diagnosis of foreign bodies of the colon and rectum. Rev Assoc Med Bras (1992) 2017; 62:818-821. [PMID: 28001252 DOI: 10.1590/1806-9282.62.09.818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 12/18/2022] Open
Abstract
Although the ingestion of foreign bodies is a common clinical problem, severe complications such as perforation are rare and occur in less than 1% of cases. Different types of foreign bodies and the various affected regions within the gastrointestinal tract make foreign body ingestion a complex entity, with a wide range of presentation requiring different diagnostic modalities. We report two cases of patients who underwent endoscopic ultrasound for evaluation of sub-epithelial lesions consisting of foreign body granulomas in the colon and rectum. Colorectal foreign body granuloma is a rare complication after accidental ingestion. Endoscopic ultrasound can be a useful diagnostic tool and can avoid the need for more invasive procedures.
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Affiliation(s)
- Fabio Gontijo Rodrigues
- MD, PhD, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA. Endoscopia Clínica e Cirúrgica, Belo Horizonte, MG, and Researcher from the CNPq, Brazil
| | | | - Giovanna DA Silva
- MD, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- MD, PhD (Hon), Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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29
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Follow-up of surgical and minimally invasive treatment of Achilles tendon pathology: a brief diagnostic imaging review. Musculoskelet Surg 2017; 101:51-61. [PMID: 28197895 DOI: 10.1007/s12306-017-0456-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
The follow-up of an operated tendon is primarily clinical, although clinical examination may not be sufficient in the presence of certain complications. The imaging techniques are of great value not only in the diagnosis of tendon pathologies, but also as an adjunct to clinical evaluation. This is particularly true in the follow-up of patients submitted to surgical tendon reconstruction, by monitoring morphological effects of different interventions and evaluating tendon healing processes. Interpretation of imaging findings requires knowledge of the imaging appearance of the operated tendon during the healing phase, to distinguish between normal postsurgical changes and real pathology, as well as knowledge of surgical technique, postoperative course (including type of prescribed therapy) and possible postoperative complications. The most important imaging modalities to examine the Achilles tendon are ultrasound and magnetic resonance imaging. This article gives a review of some of the most common treatment strategies for Achilles tendon pathology, expected postoperative imaging findings and postoperative complications.
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30
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Anterior cruciate ligament reconstruction: MR imaging findings. Musculoskelet Surg 2017; 101:23-35. [PMID: 28197894 DOI: 10.1007/s12306-017-0460-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 01/13/2023]
Abstract
More than two million people tear their anterior cruciate ligament (ACL) each year, and ACL reconstruction occupies a significant proportion of everyday orthopedic practice, being one of the most commonly performed sports medicine surgical procedures. Patients with postoperative symptoms are frequently imaged to monitor ligament grafts and to identify complications. Given the number of patients undergoing ACL reconstruction, knowledge of the potential complications of this surgery is essential for radiologists. This article provides a review of imaging of ACL reconstruction procedures and the potential complications specific to this surgery.
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31
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Barile A, Bruno F, Mariani S, Arrigoni F, Reginelli A, De Filippo M, Zappia M, Splendiani A, Di Cesare E, Masciocchi C. What can be seen after rotator cuff repair: a brief review of diagnostic imaging findings. Musculoskelet Surg 2017; 101:3-14. [PMID: 28194577 DOI: 10.1007/s12306-017-0455-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 01/08/2023]
Abstract
Diagnostic imaging plays an important role in the postoperative evaluation of the rotator cuff, as pain and disability may occur or persist after treatment. Postoperative imaging is therefore of paramount importance for clinicians before planning additional treatments. Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Correct interpretation of imaging findings of the postoperative shoulder necessitates that the radiologist be familiar with the various treatment strategies, their possible complications and sources of failure, knowledge of normal and abnormal postoperative findings, and awareness of the advantages and weaknesses of the different imaging techniques. Imaging findings, however, should always be correlated with the clinical presentation because postoperative imaging abnormalities do not necessarily correlate with symptoms. This manuscript is a review of some of the most common treatment strategies for rotator cuff pathology, with a focus on expected postoperative imaging findings and postoperative complications.
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Affiliation(s)
- A Barile
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy.
| | - F Bruno
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy
| | - S Mariani
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy
| | - F Arrigoni
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy
| | - A Reginelli
- Department of Internal Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - M De Filippo
- Department of Surgical Sciences, University of Parma, Parma Hospital, Parma, Italy
| | - M Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Splendiani
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy
| | - E Di Cesare
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy
| | - C Masciocchi
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital Coppito, Via L. Natali, 67100, L'Aquila, Italy
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Caranci F, Leone G, Ugga L, Cesarano E, Capasso R, Schipani S, Bianco A, Fonio P, Briganti F, Brunese L. Imaging of post-surgical treatment and of related complications in spinal trauma. Musculoskelet Surg 2017; 101:63-73. [PMID: 28168635 DOI: 10.1007/s12306-017-0457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
Spinal trauma is a devastating event with a high morbidity and mortality. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity of the lesions, to evaluate the potential spinal instability. In case of spinal instability, the goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Particularly, diagnostic imaging, mainly by CT and MR, has a main role in the post-treatment evaluation. The neuroradiological evaluation of the postoperative spine requires a general knowledge of the surgical approach to each spinal region and of the normal temporal evolution of expected postoperative changes. The neuroradiologist should evaluate the devices implanted, their related complications and promptly alert the surgeon of acute complications, mainly vascular and infective. During the follow-up, it is mandatory to know and search chronic complications as pseudomeningocele, accelerated degenerative disease, arachnoiditis, peridural fibrosis. Knowledge of specific complications relating to each surgical approach will assist the neuroradiologist in interpretation of postoperative images.
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Affiliation(s)
- F Caranci
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy.
| | - G Leone
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Ugga
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - E Cesarano
- Radiology Section, Health Service, Navy Command of Brindisi, Brindisi, Italy
| | - R Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - S Schipani
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - A Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Briganti
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
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De Filippo M, Pesce A, Barile A, Borgia D, Zappia M, Romano A, Pogliacomi F, Verdano M, Pellegrini A, Johnson K. Imaging of postoperative shoulder instability. Musculoskelet Surg 2017; 101:15-22. [PMID: 28168636 DOI: 10.1007/s12306-017-0461-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 01/02/2023]
Abstract
Postoperative imaging in shoulder instability is still a challenge for radiologists due to various postsurgical anatomical findings that could be considered pathologic in treated shoulder. For this reason is very important a deep knowledge about surgical procedures, anatomical changes after surgery and the appropriate diagnostic imaging modalities to work up the symptomatic postoperative shoulder. Postoperative imaging options include use conventional radiography, magnetic resonance imaging (MRI), MRI arthrography, computed tomography (CT) and CT arthrography. The purpose of our review is to explain the different surgical procedures and to describe postoperative changes detected with radiological imaging.
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Affiliation(s)
- M De Filippo
- Department of Medicine and Surgery, University of Parma and Parma Hospital, Via Gramsci, 14, 43100, Parma, Italy.
| | - A Pesce
- Department of Medicine and Surgery, University of Parma and Parma Hospital, Via Gramsci, 14, 43100, Parma, Italy
| | - A Barile
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - D Borgia
- Department of Radiology ASL Lecce, Lecce, Italy
| | - M Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Romano
- Campolongo Hospital, Salerno, Italy
| | - F Pogliacomi
- Department of Surgical Sciences, Section of Orthopaedic Clinic, Parma Hospital, University of Parma, Parma, Italy
| | - M Verdano
- Department of Surgical Sciences, Section of Orthopaedic Clinic, Parma Hospital, University of Parma, Parma, Italy
| | - A Pellegrini
- Department of Surgical Sciences, Section of Orthopaedic Clinic, Parma Hospital, University of Parma, Parma, Italy
| | - K Johnson
- Fairfax Radiological Consultants, Washington, DC, USA
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Splendiani A, D'Orazio F, Patriarca L, Arrigoni F, Caranci F, Fonio P, Brunese L, Barile A, Di Cesare E, Masciocchi C. Imaging of post-operative spine in intervertebral disc pathology. Musculoskelet Surg 2017; 101:75-84. [PMID: 28168634 DOI: 10.1007/s12306-017-0453-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 12/17/2022]
Abstract
This work is an imaging review of spine after surgery with special regard to imaging modality in intervertebral disc pathology. Advances in imaging technology can be evaluated. Depending on the clinical question is asked to the radiologist, it is possible to evaluate post-operative patients with conventional radiology (X-ray), computed tomography and magnetic resonance. Main indications for each technique are analysed. Imaging is important in the diagnosis of many forms of spine pathology and plays a fundamental role in evaluating post-surgical effects of treatments, according to the imaging method which is used, both on spine and on its surrounding tissues (intervertebral discs, spinal cord, muscles and vessels).
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Affiliation(s)
- A Splendiani
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - F D'Orazio
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - L Patriarca
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Arrigoni
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Caranci
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Brunese
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Barile
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - E Di Cesare
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - C Masciocchi
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Ngatchou W, Lemogoum D, Essola B, Ramadan A, Ngassa M, Guimfacq V, Mols P, Towo PY. Cannabis body packing: a case report. Pan Afr Med J 2016; 24:327. [PMID: 28154682 PMCID: PMC5267818 DOI: 10.11604/pamj.2016.24.327.9450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/21/2016] [Indexed: 11/13/2022] Open
Abstract
Drug traffic is a major concern worldwide. We report a case of a 27-year old male who presented with a diffuse abdominal plain to the emergency department. Abdominal X-ray demonstrated multiple foreign bodies along the intestinal tract, which were found to be cannabis packets. The patient was treated conservatively with a good result.
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Affiliation(s)
- William Ngatchou
- Department of Cardiac Surgery, St Pierre Hospital, Brussels, Belgium; Department of Emergency Medicine, St Pierre Hospital, Brussels, Belgium
| | | | | | - Ahmed Ramadan
- Department of Emergency Medicine, St Pierre Hospital, Brussels, Belgium
| | - Michèle Ngassa
- Department of Gastroenterology, Brugmann Hospital, Brussels, Belgium
| | - Virginie Guimfacq
- Department of Cardiology, Ixelles Hospital Brussels, Brussels, Belgium
| | - Pierre Mols
- Department of Emergency Medicine, St Pierre Hospital, Brussels, Belgium
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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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Added value of lung window in detecting drug mules on non-contrast abdominal computed tomography. Radiol Med 2016; 121:472-7. [PMID: 26830789 DOI: 10.1007/s11547-015-0618-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/21/2015] [Indexed: 01/08/2023]
Abstract
We evaluated the added value of lung window in non-contrast computed tomography (CT) of suspected body packers or stuffers. Forty suspected drug mules who were referred to our tertiary toxicology center were included. The final diagnosis of drug mule was based on the detection of packs in stool examination or surgery. Non-contrast CT scans were retrospectively interpreted by two blinded radiologists in consensus before and after reviewing the lung window images. The diagnostic performance of abdominal window scans alone and scans in both abdominal and lung windows were subsequently compared. Seven body packers and 21 body stuffers were identified. The sensitivity, negative predictive value (NPV), and diagnostic accuracy of scans in detection of drug mules (either drug packers or stuffers) raised from 60.7, 52.1, and 72.5 to 64.2, 54.5, and 75.0 %, respectively, with a more number of packs being detected (114 vs. 105 packs). In the body packers group, the diagnostic performance of both abdominal windows scans and combined abdominal and lung windows scans were 100 %. In the body stuffers group, the sensitivity, NPV, and diagnostic accuracy of scans increased from 47.6, 52.1, and 55.0 to 52.3, 54.5, and 57.5 %, respectively, after the addition of lung windows. Reviewing the lung window on non-contrast abdominal CT can be helpful in detection of drug mules.
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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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Lo Re G, Mantia FL, Picone D, Salerno S, Vernuccio F, Midiri M. Small Bowel Perforations: What the Radiologist Needs to Know. Semin Ultrasound CT MR 2015; 37:23-30. [PMID: 26827735 DOI: 10.1053/j.sult.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The incidence of small bowel perforation is low but can develop from a variety of causes including Crohn disease, ischemic or bacterial enteritis, diverticulitis, bowel obstruction, volvulus, intussusception, trauma, and ingested foreign bodies. In contrast to gastroduodenal perforation, the amount of extraluminal air in small bowel perforation is small or absent in most cases. This article will illustrate the main aspects of small bowel perforation, focusing on anatomical reasons of radiological findings and in the evaluation of the site of perforation using plain film, ultrasound, and multidetector computed tomography equipments. In particular, the authors highlight the anatomic key notes and the different direct and indirect imaging signs of small bowel perforation.
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Affiliation(s)
- Giuseppe Lo Re
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy.
| | - Francesca La Mantia
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Dario Picone
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Sergio Salerno
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Federica Vernuccio
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
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Faggian A, Berritto D, Iacobellis F, Reginelli A, Cappabianca S, Grassi R. Imaging Patients With Alimentary Tract Perforation: Literature Review. Semin Ultrasound CT MR 2015; 37:66-9. [PMID: 26827740 DOI: 10.1053/j.sult.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alimentary tract perforation is a frequent emergency condition. Imaging plays an important role to make an accurate diagnosis, defining the presence, the level, and the cause of the perforation, essential information to enable the most correct therapeutic choice. Plain radiography is generally performed as the first choice. In case of a clinically suspected bowel perforation, not detected on x-ray imaging, the contribution of computed tomography is essential. Magnetic resonance is not yet widely used in diagnostic workup of patients with acute abdominal pain, but it can be useful in the differential diagnosis of acute abdomen in specific patients (pregnancy and pediatric patients).
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Affiliation(s)
- Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Daniela Berritto
- Institute of Radiology, Second University of Naples, Naples, Italy
| | | | | | | | - Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
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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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Pinto A, Miele V, Pinto F, Mizio VD, Panico MR, Muzj C, Romano L. Rectal Foreign Bodies: Imaging Assessment and Medicolegal Aspects. Semin Ultrasound CT MR 2015; 36:88-93. [DOI: 10.1053/j.sult.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Grassi R, Faggian A, Somma F, De Cecco CN, Laghi A, Caseiro-Alves F. Application of imaging guidelines in patients with foreign body ingestion or inhalation: literature review. Semin Ultrasound CT MR 2014; 36:48-56. [PMID: 25639177 DOI: 10.1053/j.sult.2014.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach.
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Affiliation(s)
- Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Francesco Somma
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - Carlo Nicola De Cecco
- Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza, Latina, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza, Latina, Italy
| | - Filipe Caseiro-Alves
- Universitary Clinic of Radiology, Coimbra University Hospitals, Coimbra, Portugal
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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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Pinto A, Lanza C, Pinto F, Grassi R, Romano L, Brunese L, Giovagnoni A. Role of plain radiography in the assessment of ingested foreign bodies in the pediatric patients. Semin Ultrasound CT MR 2014; 36:21-7. [PMID: 25639174 DOI: 10.1053/j.sult.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ingestion of various types of foreign bodies (FBs) such as coins, toy parts, jewelry pieces, needles and pins, fish and chicken bones, and button-type batteries is common among children. The curiosity of children and their need to investigate the world around them place them at a higher risk for ingestion of FBs. Fortunately, 80%-90% of ingested foreign objects that reach the stomach will pass uneventfully without intervention. The remainder may become blocked in the esophagus or other region of the alimentary tract, placing the pediatric patient at risk of significant complications such as aspiration, obstruction, bleeding, perforation, fistulization, sepsis, and death. The goals of the initial pediatric patient assessment are to identify the type of object ingested, its location in the gastrointestinal tract, and the presence of associated complications. Factors reported to increase the risk of complications included a sharp FB, a FB with a wide diameter, and symptoms. Plain radiographs still play an important role in the assessment of ingested FBs in the pediatric patient: plain films of the neck, chest, and abdomen are very useful in confirming the diagnosis of FB ingestion because most ingested FBs are radiopaque.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy.
| | - Cecilia Lanza
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
| | - Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Roberta Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Luca Brunese
- Department of Health Science, University of Molise, Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
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46
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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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