Body Packing — The Internal Concealment of Illicit Drugs

Traub, Stephen J.; Hoffman, Robert S.; Nelson, Lewis S.

doi:10.1056/nejmra022719

Cited by 291 publications

(310 citation statements)

References 36 publications

(23 reference statements)

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“…They are increasingly seen in cases of ingested foreign bodies in the alimentary tract, and their sharp edges may occasionally cause perforation of the intestine [1][2][3] . Most cases of ingested PTP-induced small bowel obstruction or perforation are difficult to diagnose [1,3,4] , but some reports showed that PTPs were sometimes detected on CT [2,5] , and the possibility of exact diagnosis might be increasing by high-resolution CT, like the current case. The specific characteristics of their CT images, such as a round low-density shadow with an internal high-density part ( Figure 1A) or low-density shadow accompanied by linear highdensity parts ( Figure 1B), might be helpful for diagnosis.…”

mentioning

confidence: 63%

Computed Tomographic Demonstration of Ingested Press-Through Packages Causing Small Intestinal Perforation

Fujikawa

Yuasa

Hayashi

2016

Journal of Gastroenterology and Hepatology Research

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Press-through packages (PTPs) are regularly used to enclose drugs, and are increasingly seen in cases of ingested foreign bodies in the alimentary tract. Most cases of ingested PTP-induced bowel perforation are difficult to diagnose. We herein present a case of preoperative computed tomography (CT) demonstration showing ingested PTPinduced small intestinal perforation. An index of high suspicion and early exact diagnosis by high-resolution CT are requisite to avoid deterioration of the patients' condition and to improve outcome. Journal of Gastroenterology and Hepatology Research 2157 Fujikawa T et al . CT images of ingested PTPs causing intestinal perforationFigures 1 (A) High-resolution plain CT scan of the abdomen demonstrated free air around the small intestine at the right lower abdomen and a round low-density shadow with an internal high-density part inside the small intestine. (B) Another similar low-density shadow accompanied by linear high-density parts was also seen. (C,D) On emergency laparotomy, a laceration of the middle ileum due to a pressthrough package (PHP) was found (a yellow arrow). Extraction of two PHPs followed by partial resection of the lacerated ileum was performed. CONFLICT OF INTERESTThe authors declare that they do not have conflict of interests. Peer reviewer: REFERENCES

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confidence: 63%

Computed Tomographic Demonstration of Ingested Press-Through Packages Causing Small Intestinal Perforation

Fujikawa

Yuasa

Hayashi

2016

Journal of Gastroenterology and Hepatology Research

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“…Body packing is a recognized mean of smuggling drugs worldwide [1][2][3][4][5][6][7][8][9][10][11][12][13]. First reported case of body packing of drugs in medical literature was reported in 1973, a case of swallowing Hashish packed in condoms [2].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand the pushers use laxatives or enemas to empty the rectum before pack the transporting media in the rectum. The smugglers frequently pack the material in capsule shape packs [1,3,6,11,12]. The packets are made out of various materials, the most common is latex condoms which are easily available and can be swallowed or inserted into the rectum or the vagina easily.…”

Section: Discussionmentioning

confidence: 99%

“…Opiate toxicity should be suspected when the clinical triad of pupillary miosis, central nervous system (CNS) depression and respiratory depression is present. Cocaine overdose causes euphoria, anxiety, behavioral change, acute toxic psychosis, muscle rigidity, mydriasis, fever, diaphoresis, tachycardia and hypertension followed by seizures and cardiovascular collapse [3,12,16]. Gold is an innate substance and does not give rise to toxic effects but they can be give rise to bowel obstruction.…”

Section: Discussionmentioning

confidence: 99%

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Two Case of Body Packing of Gold in Sri Lanka

Silva¹

2017

FRCIJ

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“…Computed tomography (CT) and abdominal ultrasound are more routinely available, though neither have exceptional negative predictive values [2][3][4]. It is also understood that in some localities the practice is to detain suspicious travelers and simply await the passage of several bowel movements.…”

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confidence: 99%

In response to “Detection of body packing by magnetic resonance imaging: a new diagnostic tool?”

et al. 2013

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We read with interest the recent report concerning the use of magnetic resonance imaging (MRI) to identify intestinal packets of illicit drug in suspected body packers [1]. We feel that several clarifications are required, however, before the authors' conclusions can be accepted.While it is not surprising that MRI can detect such packets, this study does not address how MRI performs in comparison to other diagnostic modalities. Computed tomography (CT) and abdominal ultrasound are more routinely available, though neither have exceptional negative predictive values [2][3][4]. It is also understood that in some localities the practice is to detain suspicious travelers and simply await the passage of several bowel movements. There was no mention of whether MRI was the only diagnostic procedure used in the population studied. It is stated that one subject underwent CT, but it is unclear whether that was the only case. If other diagnostics were also used in these patients an assessment of the positive and negative predictive values could have occurred.Additionally, it is unclear who interpreted the MRI images and whether they were blinded to the objectives of the study. Assuming it was considered unethical to expose subjects to multiple tests, the study conclusions would have been strengthened if the interpreters were asked to analyze a group of MRI images which included the study population and a negative control population without being told that some were suspected body packers.We wondered how the ethical concerns regarding the evaluation of subjects in custody of legal authorities were addressed. For example, the authors state that all subjects signed informed consent, but it is unclear what options were presented and if there was the potential for coercion.Finally, the authors state that body packers use ''parasympathomimetic drugs'' to prevent defecation while in transit. These medications are cholinergic and stimulate gastrointestinal motility, a potentially undesirable situation for a body packer. Antimuscarinic (anticholinergic; parasympatholytic) medications, which result in decreased peristalsis, are likely what the authors intended to write.In conclusion, we agree that MRI has the potential to be a useful test in the evaluation of travelers who are suspected of being body packers due to the lack of radiation exposure. Considering the cost and lack of availability of MRI and the lack of comparison with plain radiographs or CT, or simply awaiting defection, broad implementation cannot be recommended at this time.

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Body Packing — The Internal Concealment of Illicit Drugs

Cited by 291 publications

References 36 publications

Computed Tomographic Demonstration of Ingested Press-Through Packages Causing Small Intestinal Perforation

Computed Tomographic Demonstration of Ingested Press-Through Packages Causing Small Intestinal Perforation

Two Case of Body Packing of Gold in Sri Lanka

In response to “Detection of body packing by magnetic resonance imaging: a new diagnostic tool?”

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