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.
Introduction: Rectus sheath haematoma is a rare condition which is often misdiagnosed. Apart from abdominal trauma and anticoagulation, severe coughing is an uncommon precipitating cause of this rare condition. Case presentation: An elderly gentleman with history of ischaemic heart disease on aspirin developed rectus sheath haematoma due to severe coughing during an episode of acute exacerbation of chronic obstructive pulmonary disease. He developed severe abdominal pain and was noted to have epigastric bruising extending to bilateral loins. Ultrasound abdomen and computed tomography of the abdomen with contrast revealed haematoma over bilateral upper rectus abdominis muscles, which subsided with conservative management. Discussion and conclusion: Rectus sheath haematoma can be related to severe coughing. In patients, especially those with predisposing factors, presenting with abdominal pain and palpable painful abdominal mass, clinicians should raise the suspicion of this uncommon cause so that timely and appropriate management can be provided.
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