Surgical care for ingested cocaine packets: Case report and literature review

Elkbuli, Adel; Ehrhardt, John D.; Hai, Shaikh; McKenney, Mark; Boneva, Dessy

doi:10.1016/j.ijscr.2019.01.013

Cited by 10 publications

(19 citation statements)

References 13 publications

(15 reference statements)

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“…In adults, most impactions occur during eating, leading to impaction of either bone and/or meat. Adult patients who intentionally swallow a true foreign body are typically younger, and more likely to have a history of psychiatric illness or possibly drug trafficking[ 7 , 26 , 27 ]. Unintentional FOI, however, is more commonly seen in the elderly[ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review

Cha

Sandooja

Khalid

et al. 2021

WJGE

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BACKGROUND Foreign object ingestion (FOI) and food bolus impaction (FBI) are common causes of emergent endoscopic intervention. The choice of sedation used is often dictated by physician experience. Many endoscopists frequently prefer to use monitored anesthesia care (MAC) and general anesthesia (GA) as opposed to conscious sedation (CS) due to the concern for inadequate airway protection. However, there is insufficient data examining the safety of different sedation modalities in emergent endoscopic management of FOI and FBI. AIM To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities. METHODS We conducted a retrospective chart review of patients presenting with acute FBI and FOI between 2010 and 2018 in two hospitals. A standardized questionnaire was utilized to collect data on demographics, endoscopic details, sedation practices, hospital stay and adverse events. Complications recognized during and within 24 h of the procedure were considered early, whereas patients presenting with a procedure-related adverse event within two weeks of the index event were considered delayed complications. Complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation types, namely CS, MAC and GA. Chi-square analysis and multiple logistic regression were used to compare complication rate based on sedation type. RESULTS Among the 929 procedures analyzed, 353 procedures (38.0%) were performed under CS, 278 procedures (29.9%) under MAC and the rest (32.1%) under GA. The median age of the subjects was 52 years old, with 57.4% being male. The majority of the procedures (64.3%) were FBI with the rest being FOI (35.7%). A total of 132 subjects (14.2%) had chronic comorbidities while 29.0% had psychiatric disorders. The most commonly observed early complications were mucosal laceration (3.8%) and bleeding (2.6%). The most common delayed complication was aspiration pneumonia (1.8%). A total of 20 patients (5.6%) could not adequately be sedated with CS and had to be converted to MAC or GA. Patient sedated with MAC and GA were more likely to require hospitalization, P < 0.0001. Analysis revealed no statistically significant difference in the complication rate between patients sedated under CS (14.7%), MAC (14.7%) and GA (19.5%), P = 0.19. CONCLUSION For patients who present with FOI or FBI and undergo emergent endoscopic treatment, there is no significant difference in adverse event rates between CS, MAC and GA.

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Section: Discussionmentioning

confidence: 99%

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review

Cha

Sandooja

Khalid

et al. 2021

WJGE

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“…Management is multimodal and ranges from simple laxatives and mechanical bowel preparation to a more invasive approach involving endoscopy and surgery. The factors that guide your approach are determined by the radiological evidence of the amount of packets, the location of these packets in the gastrointestinal tract, and the physiological state of the patient [ 1 ]. In most cases where a conservative approach has been used, the patient has shown no signs of toxicity and has ingested a relatively small number of packets compared to our case.…”

Section: Discussionmentioning

confidence: 99%

“…Cases of body packing of illicit substances for smuggling have been reported in the medical literature since 1971, and is a worldwide phenomenon [ 1 ]. Cocaine is the most frequently transported drug; the UK National Crime Agency reported seizing 122.9 tonnes of this Class A substance from 2017 to 2018 [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Cocaine Body Packing: A New Record

Tanna¹,

Bostina²,

Lloyd³

et al. 2020

Cureus

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We present a case of a 39-year-old man who was brought in by ambulance to the ED after ingesting 103 packets of cocaine prior to return to the United Kingdom (UK) from Holland. He presented with a persistent sinus tachycardia and mild abdominal pain but no evidence of peritonitis on examination. Contrastenhanced CT showed widespread distribution of packets from the stomach to the sigmoid colon. He was taken to theater for emergency laparotomy and retrieval of the packets, which was done successfully without the need of any bowel resection. He was then discharged to police custody following a 10-day admission. This is the highest number of cocaine packets reported in the UK literature. This case report discusses the importance of a multidisciplinary approach in safely managing body packers who also present with signs of cocaine toxicity.

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“…The extraction of the content can be performed by various means, such as laxatives, stimulation of intestinal peristalsis, and invasive procedures such as endoscopy and emergency surgery, with the latter being considered the safest route. However, the choice of treatment depends on the radiological findings and the patient's clinical condition [15,16]. Thus, to investigate body packing of both narcotic and non-narcotic contents, this study aimed to identify and describe cases of body packers treated by a surgical emergency unit in a tertiary hospital in the central region of Brazil.…”

Section: Introductionmentioning

confidence: 99%

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones and Beyond

Guimarães

Cassiano

Queiroz

et al. 2021

Preprint

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Introduction: Body packing is the smuggling of drugs and other contents inside the human body. However, non-narcotic contents studies are limited to rare case reports in literature. Thus, the objective of this study was to investigate cases of body packers in Brazil considering narcotic and non-narcotic contents. Methods: Retrospective study analyzing the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil. Results: Ten cases of body packing were observed. Only 50% of the patients carried drugs, while surprisingly, 70% carried non-content, especially cell phones and accessories. All the patients were male, prisoners and young adults. In 60%, there were gastrointestinal obstruction and in 30%, there was acute narcotic intoxication. Abdominal radiography was enough for diagnosis in 80% of the cases. In 90% of the cases, emergency laparotomy was required, but all the patients successfully recovered. Conclusions: There was a higher prevalence of body packing of non-narcotic content; however, clinical and radiological presentations were similar to those of narcotic content. Emergency surgery proved to be effective for both content types. This study highlights the concerning high prevalence of body packing of cell phones and accessories in addition to drugs.

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Surgical care for ingested cocaine packets: Case report and literature review

Cited by 10 publications

References 13 publications

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review

Cocaine Body Packing: A New Record

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones and Beyond

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