The role of surgery in the management of “body packers”

Abstract

Conservative management was effective in 94 % of symptomatic patients. A laparotomy was required in only 3.5 % of cases. The mortality rate in this series was low, resulting from either severe cocaine poisoning from ruptured packets or bowel perforation.

Emergency department management of body packers and body stuffers

“…The rate of rupture of drug packages was nil in our cohort (composed mostly of body stuffers), in contrast to a reported rate of 1.4% [6]; it seems to depend mostly on the quality of the packaging, which differs according to the country of origin [2]. Nonetheless, in light of the ever-present risk of rupture of packages, and the subsequent imminent risk of death [4][5][6]23], in-hospital surveillance seems necessary for all body packers and body stuffers until expulsion of all the drug packages, as is practiced in France and Germany [19]. In our setting, the diagnostic procedure always includes the use of a CT scan to confirm the internal concealment of drugs, as a result of the low sensitivity of plain X-ray to reveal the presence of small packages of drugs in the body stuffers [6,[15][16][17].…”

“…Some authors have suggested an in-hospital observation period of 6 hours, arguing that this constitutes a safe minimum [22], although this was not confirmed in other studies. In the event of a sympathomimetic toxidrome occurring in a body packer, immediate surgical intervention is recommended in light of the high mortality due to rupture of a cocaine packet [4,6,23]. In the case of uncertainty regarding rupture of cocaine packets, a urinary screening test could be performed to confirm the intoxication.…”

“…Gas chromatography or mass spectroscopy analysis are, of course, more precise ways to confirm the rupture or leak of the package; these tests are, however, frequently not readily available for clinical use. The risks of intragastric stasis, obstruction, or intestinal perforation in body packers are well documented [9,18,[23][24][25]. The rate of laparotomy varies widely in the literature owing to the large variation in the indications to perform such an intervention.…”

Síndrome pilórico en un body packer

“…De acuerdo con lo anterior, el manejo quirúrgico debe reservarse únicamente para casos de obstrucción intestinal, sospecha de perforación, hemorragia digestiva o intoxicación aguda grave con probabilidad de ruptura de los paquetes 2,5,6,8 . Existe controversia respecto a la indicación de cirugía en pacientes con falla en la expulsión de los paquetes después de un periodo determinado de observación, pero algunas publicaciones consideran que después de cuatro o cinco días sin obtener resultados, se debe realizar cirugía teniendo en cuenta que, el contacto prolongado con la mucosa intestinal favorece la absorción de la droga a través de la membrana semipermeable e incrementa el riesgo de ruptura [2][3][4][5] .…”

“…La incidencia de obstrucción intestinal en "body packers" es aproximadamente el 5 % 3 . La zona más frecuente de obstrucción es el intestino delgado, con muy pocos casos reportados a nivel gástrico 6,8 . El objetivo de este artículo fue describir el caso de un hombre con síndrome pilórico secundario a la ingesta de 101 paquetes para el transporte de sustancias ilegales y presentar las principales consideraciones sobre el abordaje terapéutico del "body packing".…”