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

Abstract

Emergency physicians and radiologists have been increasingly encountering internal concealment of illegal drugs. The packages commonly contain powdered solid drugs such as cocaine, heroin, methamphetamine and hashish, but they may also contain cocaine in the liquid form. The second type of package has recently been more commonly encountered, and poses a greater diagnostic challenge. As clinical evaluation and laboratory tests frequently fail to make the correct diagnosis, imaging examination is typically required. Imaging methods assume a vital role in the diagnosis, follow-up and management. Abdominal X-ray, ultrasonography, CT and MRI are used for the imaging purposes. Among the aforementioned methods, low-dose CT is state-of-the-art in these cases. It is of paramount importance that radiologists have a full knowledge of the imaging characteristics of these packages and accurately guide physicians and security officials.

A Curious Case of the Persistent Body Stuffer

“…Body packers and body stuffers utilize intracorporeal concealment of illicit drugs in individuals with the aim of eluding police and other agencies and avoiding detection [1–3]. These two subsets of individuals are frequently brought to the emergency department (ED) for either acute drug ingestion, symptoms of intestinal obstruction, or for medical clearance [4–6].…”

“…These two subsets of individuals are frequently brought to the emergency department (ED) for either acute drug ingestion, symptoms of intestinal obstruction, or for medical clearance [4–6]. Differentiating between body packers and body stuffers is based on the reason for concealment, amount of drug ingested, and the method of concealment [1, 7, 8]. Body packers, often referred to as “mules”, “couriers”, and “swallowers” are individuals who intentionally and methodically “swallow or insert drugs into a body cavity with the purpose of smuggling them across secure borders” [4].…”

“…In addition, complications arising from packet rupture can be unpredictable and diverse, due to the alteration of drugs with other substances, which presents a diagnostic and therapeutic challenge for the emergency medicine physician [4, 11]. Given the difficulty in obtaining an accurate history, and the often nonspecific clinical presentation and laboratory tests, radiographic modalities play an important role in the diagnosis, follow-up, and management [1]. For the emergency department physician, abdominal X-ray, ultrasonography, and computed tomography (CT) are the mainstay of imaging, with noncontrast CT considered to be the study of choice [1, 13–15].…”

“…Given the difficulty in obtaining an accurate history, and the often nonspecific clinical presentation and laboratory tests, radiographic modalities play an important role in the diagnosis, follow-up, and management [1]. For the emergency department physician, abdominal X-ray, ultrasonography, and computed tomography (CT) are the mainstay of imaging, with noncontrast CT considered to be the study of choice [1, 13–15]. Treatment is multifactorial, based on type and amount of ingested drug, and the presence of symptoms.…”

Management recommendations for body stuffers at emergency units

“…Body stuffing, in turn, stands for quick ingestion of drugs to avoid police arrest (8)(9)(10). Body stuffers usually swallow one to fifteen 0.5-2-cm packages (7).…”