Imaging of body packing: errors and medico-legal issues

Abstract

Body packing is the ingestion or insertion in the human body of packed illicit substances. Over the last 20 years, drug smuggling has increased global and new means of transport of narcotics have emerged. Among these, the most frequent one is the gastrointestinal tract: from mouth to anus, vagina, and ears. Cocaine is one of the most traded drugs, followed by heroin. Condoms, latex gloves, and balloons are typically used as drug packets for retention in the body. There are different radiologic modalities to detect illicit drugs in body packing: Plain radiography, computed tomography (CT), ultrasound, and magnetic resonance. Current protocols recommend the use of radiography to confirm packet retention and, in case of doubt, the use of abdominal CT scan with reduced mAs. In case of packet rupture, catastrophic effects can occur. Management of patients carrying packets of drugs is a recurrent medico-legal problem. To improve diagnostic accuracy and prevent hazardous complications, radiologists and emergency physicians should be familiar with radiologic features of body packing. The radiologist plays both a social and a medico-legal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location. In this review, we focus on diagnostic errors and medico-legal issues related to the radiological assessment of body packers.

Outpatient management of individuals transporting drugs by body packing is feasible

“…This is comparable to the Lausanne cohort, as well as to bigger cohorts in Europe showing very low complication rates (1.2-2.3%) and no rupture of drug packages [4,9,15]. New wrapping techniques might reduce package rupture [14]. Only patients with proven body packs and high-risk features were recommended for further diagnostic work-up and observation, according to the largest published case series [9,15].…”

“…On the other hand, body packers might use new wrapping techniques with lower radio-density, ultimately resulting in more false negative results [14]. Additionally, better training of radiologists in recognising intracorporeal containers could have led to an increase in positive findings.…”

“…Indeterminate results have therefore only been observed once in the last 200 presentations. Newer studies have confirmed that low-dose CT without contrast is the most powerful imaging modality for intracorporeal drug transport, providing definite diagnosis with roughly similar radiation as compared to plain radiographs [2,14,18].…”

Cardiac Arrest in the Airport Revealing Cocaine Body Packing: A Case Report

“…In some countries like Hong Kong, informed consent must be obtained prior to the radiological examination, whereas in other countries like France or the UK, informed consent is not required and radiological examinations may be performed at the request of a customs officer or following a judicial injunction. Additionally, many drug-trafficking organizations use different materials like aluminum foil, plastic food wrap, carbon paper, and cigarette paper to reduce the radiological detectability; as a result, many cases of false-negative X-ray and CT findings have been described in the literature [8, 9].…”

County lines: how gang crime is affecting our young people

“…Drugs may be transported or stored by ‘plugging’ or ‘body packing’; concealing them internally within the gastrointestinal tract or vagina, or they may be stored in the cheeks and then swallowed if they think they are going to be caught. Condoms, latex gloves and balloons are typically used as drug packets for retention, but if the packet ruptures there may be catastrophic consequences 15…”