Body Packers: The Ins and Outs of Imaging

Imaging of Drug Smuggling by Body Packing

“…67,68 In experienced hands, sonography is a specific test, but its sensitivity is considered lower than that of plain abdominal film and decreases when packets are mixed with compact echogenic stool and gas. 38 Although some reports have shown the value of US in detection of containers inserted in the vagina, 69 others showed its equal sensitivity and specificity compared with abdominal X-ray to detect containers, 30,70,71 and although Meijer and Bots 67 reported that a positive result on US examination increased the likelihood of drug containers being present up to 97.6% (positive predictive value) with an accuracy of 94%, we cannot exclude the presence of ingested drug packets with a negative result on US examination.…”

“…4,10 Repeated plain radiographs may improve results, although false positives can result from constipation induced by opiate-filled packets or antimotility drugs that body packers often take on. 38 Some authors have tried to differentiate the various types of drugs from their radiopacity. [39][40][41] The density of cocaine is more like feces or water, heroin tends to be less dense than feces, whereas cannabis is more dense than feces.…”

The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools

“…33 Gas and faeces that surround drug packages in the intestinal lumen may reduce diagnostic accuracy of the method and lead to non-identification of packages. 34,35 Former articles on this subject have reported that X-ray and ultrasonography had similar accuracies in demonstrating packages. 23,36,37 In contrast, Meijer and Bots 30 determined that the positive-predictive value and accuracy rate of ultrasonography were 97.6% and 94%, respectively.…”

“…4,25 The widely accepted view in the literature about the CT protocol for use in suspected cases is that it should be taken without rectal or oral contrast material administration because luminal contrast material may complicate the visualization of packages that have a similar density to the contrast material. 3,4,6,35 Moreover, contrast material may augment intestinal peristalsis and trigger intestinal obstruction. 4 It has been reported that in a suspected case, contrast material in the gastrointestinal lumen did not facilitate making the diagnosis; conversely, it prevented CT detection of a single remaining package in the intestinal lumen.…”

Radiological and practical aspects of body packing

“…16 Detection of body packers depends on the clinical presentation and a suggestive history. 18 Body packers generally carry about 1 kg of narcotic, separated into 50-100 packets of 8-10 g each, although the carriage of .200 packets by individual traffickers has been described. 6 The preponderance of drug couriers are young males, predominantly of coloured skin.…”