Radiological and practical aspects of body packing

Abstract

Body packing represents the concealment of illegal substances in a person's body with the aim of smuggling. "Body packers" either swallow drug-filled packets or introduce drug-filled packets into their bodies rectally or vaginally with the purpose of concealing them. The three main smuggled drugs are cocaine, heroin and cannabis products. Body packing represents a serious risk of acute narcotic toxicity from drug exposure, intestinal obstruction owing to pellet impaction and bowel perforation with consequent abdominal sepsis. A suspected body packer is generally admitted to hospital to perform imaging investigations and confirm the presence of drugs in his/her body. Radiological imaging methods are essential to diagnose body packing and to detect potential complications. Increasing sophistication of traffickers and improvements in packaging add to the detection difficulty. Radiologists should be aware of the appearance of drug packets in a range of imaging modalities. This article informs physicians about the challenging aspects of body packing, its background and medicolegal issues, what imaging methods can be used and what criteria are necessary to perform a correct diagnosis.

Small Bowel Perforations: What the Radiologist Needs to Know

“…[2][3][4][5][6][7][8] The traumatic perforations of small bowel are more frequent than nontraumatic ones. [5][6][7][9][10][11][12][13] In particular, small bowel traumatic perforation is the third in frequency among abdominal traumatic perforations following liver and spleen ones; these lesions are rarely isolated. [9][10][11][12][13] The origin of nontraumatic perforations may be infectious (typhoid fever, HIV, tuberculosis, hook worms; most common in developing countries) or noninfectious (ischemic conditions, Meckel diverticulitis, Crohn's disease, tumors, iatrogenic causes, foreign bodies, and mechanical conditions).…”

“…[5][6][7][9][10][11][12][13] In particular, small bowel traumatic perforation is the third in frequency among abdominal traumatic perforations following liver and spleen ones; these lesions are rarely isolated. [9][10][11][12][13] The origin of nontraumatic perforations may be infectious (typhoid fever, HIV, tuberculosis, hook worms; most common in developing countries) or noninfectious (ischemic conditions, Meckel diverticulitis, Crohn's disease, tumors, iatrogenic causes, foreign bodies, and mechanical conditions). [8][9][10][11][12] Clinical findings of small bowel perforation are usually not specific, sudden acute abdominal pain, vomiting, anorexia, and nausea.…”

“…[9][10][11][12][13] The origin of nontraumatic perforations may be infectious (typhoid fever, HIV, tuberculosis, hook worms; most common in developing countries) or noninfectious (ischemic conditions, Meckel diverticulitis, Crohn's disease, tumors, iatrogenic causes, foreign bodies, and mechanical conditions). [8][9][10][11][12] Clinical findings of small bowel perforation are usually not specific, sudden acute abdominal pain, vomiting, anorexia, and nausea. In this article, we report our experience, we retrospectively evaluated all CT reports from 2011-2015 searching for "Intestinal Perforation" and reviewed all the images of exams in which small bowel perforation was diagnosed.…”

“…14 However, the incidence of small bowel perforations is low and may be of various origin (ischemic, inflammatory, infectious, postoperative, bowel obstruction, volvulus, and intussusceptions) [8][9][10][11][12] and -perforation of the second and third duodenum segments may result in gas bubbles located just in the retroperitoneal space. The most common location of retroperitoneal gas is the anterior pararenal space and, in this case, gas typically outlines the lateral border of the psoas muscle.…”

Endoscopic ultrasound in the diagnosis of foreign bodies of the colon and rectum

“…11,12,15 Plain radiograph is the most commonly used modality to detect ingested foreign bodies; radiographs can reveal radioopaque objects and also assess the presence of pneumoperitoneum in cases of perforation. 16 In cases of radiolucent objects, computed tomography appears to be the modality of choice and can show the presence of abscess, free air, and any involvement of the surrounding structures. 17 Endoscopic ultrasound images can vary according to the type of foreign body.…”