Systematic review of the toxicological and radiological features of body packing

Cappelletti, Simone; Piacentino, Daria; Sani, Gabriele; Bottoni, Edoardo; Fiore, Paola Antonella; Aromatario, Mariarosaria; Ciallella, Costantino

doi:10.1007/s00414-015-1310-3

Cited by 43 publications

(34 citation statements)

References 93 publications

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“…The total value of the packages may range from US $1,000 to over US $1,000,000 (10). Consistent with the literature (10), our patient had swallowed 75% pure and type III cocaine-filled packages worth approximately US $900,000 to smuggle them across international borders.…”

Section: Discussionsupporting

confidence: 88%

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International Smuggling of Cocaine by Body Concealment: A Case Report

Kaplan¹,

Söğüt²,

Yigit³

2016

Iran Red Crescent Med J

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Introduction: We present a case report of a healthy man who ingested a large number of well-manufactured cocaine packages to smuggle them across international borders. Case Presentation: A 36-year-old man ingested cocaine packages worth approximately US $900,000 to transport it from Dubai to Madrid. He was arrested by police at Istanbul Ataturk Airport for suspected body packing of drugs. On arrival to the emergency department of our tertiary-care university hospital in Istanbul, Turkey, he confessed that he had attempted to smuggle 76 packages of cocaine in his gastrointestinal tract. The patient complained of nausea, but did not have abdominal pain. The physical examination was unremarkable. Radiological screening showed many small packages in the abdomen. There were no signs of intestinal obstruction. In this case, repeat computed tomography of the abdomen confirmed complete evacuation. The patient was discharged into police custody six hours later, after passing the number of packets that he had reported to have swallowed. Conclusions: Abdominal radiography and computed tomography are useful tools for in the evaluation of suspected body packers. Improved packaging material used by smugglers and a more conservative treatment approach have reduced the mortality and morbidity.

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Section: Discussionsupporting

confidence: 88%

“…Positive drug levels in the blood and urine of body packers reveal that either the individual has used the drug in the previous days or that one or more packages are leaking (10). A relevant limitation of this case report is due to the lack toxicological data (e.g., the cocaine levels in the blood or urine of the presented body packer).…”

Section: Discussionmentioning

confidence: 95%

International Smuggling of Cocaine by Body Concealment: A Case Report

Kaplan¹,

Söğüt²,

Yigit³

2016

Iran Red Crescent Med J

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“…Body packets remained easily detectable due to the attenuation difference compared to adjacent tissue and structures. Of note, one previous study [19] reported negative HU values for cocaine body packets with a mean attenuation of -219 HU. This does not coincide with our findings and with other studies investigating detection of cocaine body packets on CT [7,18,20,21].…”

Section: Discussionmentioning

confidence: 94%

Optimizing radiation exposure in screening of body packing: image quality and diagnostic acceptability of an 80 kVp protocol with automated tube current modulation

Aissa

Boos

Rubbert

et al. 2017

Forensic Sci Med Pathol

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The aim of this study was to evaluate the objective and subjective image quality of a novel computed tomography (CT) protocol with reduced radiation dose for body packing with 80 kVp and automated tube current modulation (ATCM) compared to a standard body packing CT protocol. 80 individuals who were examined between March 2012 and July 2015 in suspicion of ingested drug packets were retrospectively included in this study. Thirty-one CT examinations were performed using ATCM and a fixed tube voltage of 80 kVp (group A). Forty-nine CT examinations were performed using a standard protocol with a tube voltage of 120 kVp and a fixed tube current time product of 40 mAs (group B). Subjective and objective image quality and visibility of drug packets were assessed. Radiation exposure of both protocols was compared. Contrast-to-noise ratio (group A: 0.56 ± 0.36; group B: 1.13 ± 0.91) and Signal-to-noise ratio (group A: 3.69 ± 0.98; group B: 7.08 ± 2.67) were significantly lower for group A compared to group B (p < 0.001). Subjectively, image quality was decreased for group A compared to group B (2.5 ± 0.8 vs. 1.2 ± 0.4; p < 0.001). Attenuation of body packets was higher with the new protocol (group A: 362.2 ± 70.3 Hounsfield Units (HU); group B: 210.6 ± 60.2 HU; p = 0.005). Volumetric Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP) were significantly lower in group A (CTDIvol 2.2 ± 0.9 mGy, DLP 105.7 ± 52.3 mGycm) as compared to group B (CTDIvol 2.7 ± 0.1 mGy, DLP 126.0 ± 9.7 mGycm, p = 0.002 and p = 0.01). The novel 80 kVp CT protocol with ATCM leads to a significant dose reduction compared to a standard CT body packing protocol. The novel protocol led to a diagnostic image quality and cocaine body packets were reliably detected due to the high attenuation.

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“…Persons who swallow or insert drug-containing packets into a body cavity are called “body packers”. Cocaine is the most frequently transported drug, followed by heroin, metamphetamine, opium, marijuana and hashish [1–4]. According to the literature, a single body packer usually carries 50–100 packets [1].…”

Section: Introductionmentioning

confidence: 99%

“…Different types of drug packages have been described: Loosely packed cocaine powder in wrappings such as condoms is referred to as “type 1” package. Tightly packed cocaine powder or paste in multiple tubular latex layers is referred to as “type 2” or “type 3” package, the latter having an additional covering of foil [4]. The most recently described type of package, “type 4”, consists of a hardened cocaine paste wrapped in tubular latex covered with paraffin or fiberglass [4, 5].…”

Section: Introductionmentioning

confidence: 99%

A patient full of surprises: a body packer with cocaine intoxication, pneumococcal pneumonia and HIV infection

2018

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BackgroundSmuggling of illegal drugs by hiding them inside one’s own body, also called body packing, is a worldwide phenomenon. Cocaine is the most frequently transported drug. Body packing is a potentially lethal practice. The most serious complications of body packing are gastrointestinal obstruction or perforation and drug toxicity due to packet leakage or rupture.Case presentationA 30-year-old confirmed body packer was brought to our emergency department from jail because of agitation and mydriasis. He presented with a high respiratory rate of 40/min but normal oxygen saturation on ambient air, a heart rate of 116 bpm, a blood pressure of 116/68 mmHg and a temperature of 38.0° Celsius. Blood tests were suggestive of infection, urine analysis was positive for cocaine. Abdominal and thoracic computed tomography scans showed pulmonary infiltrates as a possible focus of infection; signs of bowel obstruction or perforation were absent. Given his clinical presentation, we suspected severe infection rather than massive cocaine intoxication to be the main problem. We therefore withheld immediate surgical decontamination. Instead, we started broad-spectrum antibiotic treatment with piperacillin/tazobactam plus clarithromycin for suspected severe community-acquired pneumonia or abdominal sepsis and treated the patient with intravenous midazolam for symptomatic cocaine intoxication. After detection of urinary pneumococcal antigen, the antibacterial regimen was changed to ceftriaxone and vancomycin for pneumococcal pneumonia. In addition, we found human immunodeficiency virus (HIV) type 1 infection as underlying disease. The patient recovered from his acute illness and was discharged after 7 days of treatment with ceftriaxone plus vancomycin. Antiretroviral therapy was started in an outpatient setting.ConclusionsWith this case report, we emphasize the need to look for alternative diagnoses to intoxication and gastrointestinal obstruction in acutely ill body packers with atypical presentation. Special risks, such as underlying HIV infection and potential antimicrobial resistance according to the individual’s geographical origin, should be taken into account while treating these patients.

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Systematic review of the toxicological and radiological features of body packing

Cited by 43 publications

References 93 publications

International Smuggling of Cocaine by Body Concealment: A Case Report

International Smuggling of Cocaine by Body Concealment: A Case Report

Optimizing radiation exposure in screening of body packing: image quality and diagnostic acceptability of an 80 kVp protocol with automated tube current modulation

A patient full of surprises: a body packer with cocaine intoxication, pneumococcal pneumonia and HIV infection

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