Emergency department management of body packers and body stuffers
Trafficking and sale of narcotics frequently involves the intra-abdominal transport of large quantities of drugs, usually cocaine or heroin (“body packing”), or, when there is a risk of being arrested, the oral ingestion of minor quantities of narcotics dedicated for immediate resale (“body stuffing”).
This study aimed to describe the characteristics, complications and medical follow through of 132 cases of body packing (n = 36), cases of body stuffing (n = 83) or mixed cases (n = 13), referred by the authorities to our emergency department over the course of 12 years.
Analysis of these 132 cases did not reveal any intra-abdominal rupture or leak of the packaging, or any case of acute intoxication. Nevertheless, a surgical intervention was required in three of the body packers (2.3%) owing to stasis of the packages inside the stomach. The mean length of stay was longer when the packets were located in the stomach at time of diagnosis than when they were lower in the gastrointestinal tract (61.9 vs 43.8 hours, respectively), but this was not statistically significant (p = 0.13). Length of stay was not associated with the presence of (nonspecific) symptoms or the total number of packs ingested.
In conclusion, the study of this cohort of 132 body packers and body stuffers permits us to state that the medical management of these patients is rarely associated with serious complications, and that their length of stay is generally long, averaging 2 days before complete elimination of the drug packages.
- Booker RJ, Smith JE, Rodger MP. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J. 2009;26(5):316–20. doi:.https://doi.org/10.1136/emj.2008.057695
- Bogusz MJ, Althoff H, Erkens M, Maier RD, Hofmann R. Internally concealed cocaine: analytical and diagnostic aspects. J Forensic Sci. 1995;40(5):811–5. doi:.https://doi.org/10.1520/JFS15390J
- Cappelletti S, Piacentino D, Sani G, Bottoni E, Fiore PA, Aromatario M, et al. Systematic review of the toxicological and radiological features of body packing. Int J Legal Med. 2016;130(3):693–709. doi:.https://doi.org/10.1007/s00414-015-1310-3
- June R, Aks SE, Keys N, Wahl M. Medical outcome of cocaine bodystuffers. J Emerg Med. 2000;18(2):221–4. doi:.https://doi.org/10.1016/S0736-4679(99)00198-5
- Norfolk GA. The fatal case of a cocaine body-stuffer and a literature review - towards evidence based management. J Forensic Leg Med. 2007;14(1):49–52. doi:.https://doi.org/10.1016/j.jcfm.2005.12.002
- Schaper A, Hofmann R, Bargain P, Desel H, Ebbecke M, Langer C. Surgical treatment in cocaine body packers and body pushers. Int J Colorectal Dis. 2007;22(12):1531–5. doi:.https://doi.org/10.1007/s00384-007-0324-9
- Hoffman RS, Nelson L. Internal concealment of drugs of abuse (body packing). Available from: https://www.uptodate.com/contents/internal-concealment-of-drugs-of-abuse-body-packing
- Hugli O, Schmidt S, Trueb L, Yersin B. [Cocaine: new traffic mode, new detection method and new algorithm]. Rev Med Suisse. 2008;4(167):1747–53. Article in French.
- Mandava N, Chang RS, Wang JH, Bertocchi M, Yrad J, Allamaneni S, et al. Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules). Emerg Med J. 2011;28(2):98–101. doi:.https://doi.org/10.1136/emj.2008.059717
- Traub SJ, Hoffman RS, Nelson LS. Body packing--the internal concealment of illicit drugs. N Engl J Med. 2003;349(26):2519–26. doi:.https://doi.org/10.1056/NEJMra022719
- Wong GCK, Lai KK, Chung CH. Management of body packers in the emergency department. Hong Kong J Emerg Med. 2005;12:112–8.
- Reginelli A, Russo A, Urraro F, Maresca D, Martiniello C, D’Andrea A, et al. Imaging of body packing: errors and medico-legal issues. Abdom Imaging. 2015;40(7):2127–42. doi:.https://doi.org/10.1007/s00261-015-0469-x
- Marc B, Baud FJ, Aelion MJ, Gherardi R, Diamant-Berger O, Blery M, et al. The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci. 1990;35(2):345–55. doi:.https://doi.org/10.1520/JFS12835J
- Meijer R, Bots ML. Detection of intestinal drug containers by ultrasound scanning: an airport screening tool? Eur Radiol. 2003;13(6):1312–5.
- Schmidt S, Hugli O, Rizzo E, Lepori D, Gudinchet F, Yersin B, et al. Detection of ingested cocaine-filled packets--diagnostic value of unenhanced CT. Eur J Radiol. 2008;67(1):133–8. doi:.https://doi.org/10.1016/j.ejrad.2007.07.017
- Yang RM, Li L, Feng J, Lai SS, Lin BQ, Yu T, et al. Heroin body packing: clearly discerning drug packets using CT. South Med J. 2009;102(5):470–5. doi:.https://doi.org/10.1097/SMJ.0b013e31819ecacc
- Shahnazi M, Sanei Taheri M, Pourghorban R. Body packing and its radiologic manifestations: a review article. Iran J Radiol. 2011;8(4):205–10. doi:.https://doi.org/10.5812/iranjradiol.4757
- Gherardi RK, Leporc P, Dupeyron J-P, Baud FJ, Marc B, Diamant-Berger O. Detection of drugs in the urine of body-packers. Lancet. 1988;1(8594):1076–8. doi:.https://doi.org/10.1016/S0140-6736(88)91897-1
- de Prost N, Lefebvre A, Questel F, Roche N, Pourriat JL, Huchon G, et al. Prognosis of cocaine body-packers. Intensive Care Med. 2005;31(7):955–8. doi:.https://doi.org/10.1007/s00134-005-2660-y
- Glovinski PV, Lauritsen ML, Bay-Nielsen M, Brandstrup B, Bisgaard T. Asymptomatic body packers should be treated conservatively. Dan Med J. 2013;60(11):A4723.
- Flach PM, Ross SG, Ampanozi G, Ebert L, Germerott T, Hatch GM, et al. “Drug mules” as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox. Eur J Radiol. 2012;81(10):2518–26. doi:.https://doi.org/10.1016/j.ejrad.2011.11.025
- Moreira M, Buchanan J, Heard K. Validation of a 6-hour observation period for cocaine body stuffers. Am J Emerg Med. 2011;29(3):299–303. doi:.https://doi.org/10.1016/j.ajem.2009.11.022
- Álvarez Llano L, Rey Valcalcel C, Al-Lal Y-M, Pérez Díaz M-D, Stafford A, Turégano Fuentes F. The role of surgery in the management of “body packers”. Eur J Trauma Emerg Surg. 2014;40(3):351–5. doi:.https://doi.org/10.1007/s00068-014-0388-5
- de Bakker JK, Nanayakkara PW, Geeraedts LM, Jr, de Lange ES, Mackintosh MO, Bonjer HJ. Body packers: a plea for conservative treatment. Langenbecks Arch Surg. 2012;397(1):125–30. doi:.https://doi.org/10.1007/s00423-011-0846-z
- Beckley I, Ansari NA, Khwaja HA, Mohsen Y. Clinical management of cocaine body packers: the Hillingdon experience. Can J Surg. 2009;52(5):417–21.
- Traub SJ, Su M, Hoffman RS, Nelson LS. Use of pharmaceutical promotility agents in the treatment of body packers. Am J Emerg Med. 2003;21(6):511–2. doi:.https://doi.org/10.1016/S0735-6757(03)00171-2
- Visser L, Stricker B, Hoogendoorn M, Vinks A. Do not give paraffin to packers. Lancet. 1998;352(9137):1352. doi:.https://doi.org/10.1016/S0140-6736(98)08302-0