heroin and Foreign-Bodies

Cocaine, heroin, methamphetamine, and hashish are the primary drugs transported by a body packer, who swallows such packages. A body pusher or stuffer transports drug packages in rectum or vagina. Plain radiography is the primary imaging modality used in the evaluation of concealed drugs and has sensitivity of 85-90%. The imaging features include well-defined opacities in the bowel with crescents of air near ovoid opacities. The imaging signs include double condom sign, halo sign, parallelism sign, and tic tac sign. A low-dose CT is an efficient noninvasive and accurate technique of locating packages internally for all types of concealment.

Topics: Body Packing; Cocaine; Female; Foreign Bodies; Heroin; Humans; Rectum

Death due to mechanical or chemical intoxication of heroin body packers, thanks to the continuous improvement in packaging techniques, are increasingly rare, and almost all the cases reported in the literature refer to drug swallowers. A case of fatal acute heroin intoxication in a body pusher with an unreported packaging technique is presented, and previous deaths due to heroin body packing are reviewed, taking into consideration imaging techniques performed, cause of death, toxicological analysis on biological and non-biological samples, as well as number, position and type of drug packages identified at the dissection of the body. The innovative packaging technique found in the present case, constituted by an external multilayer cellophane casing containing 16 smaller packages of hardened heroin powder, each one covered with cigarette paper and multiple layers of heat-sealed cellophane, was probably used to avoid both chemical complications of package rupture and to create a package with morphological and radiological features different from those reported by previous studies. Drug dealers, in fact, are continually looking for packaging methods that, besides being safer, minimize the risk of detection at the radiological examinations performed, thus increasing the number of false negative findings. The identification of new types of package is therefore important, in order to identify packages that do not have the typical radiological signs, both in order to protect the patient's health and to avoid the non-recognition of a drug carrier. Despite the presence of multilayer composition of both the smaller and the bigger external coverage, these new types of package did not guarantee the greater safety of the drug dealer.

Topics: Adult; Body Packing; Drug Packaging; Drug Trafficking; Foreign Bodies; Heroin; Humans; Male; Narcotics

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.

Topics: Abdomen; Cocaine; Diagnostic Errors; Diagnostic Imaging; Drug Packaging; Drug Trafficking; Foreign Bodies; Heroin; Humans; Illicit Drugs; Magnetic Resonance Imaging; Radiography, Abdominal; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Crack Cocaine; Drug Trafficking; Foreign Bodies; Heroin; Humans; Illicit Drugs; Italy; Laparotomy; Male; Risk Assessment; Sampling Studies; Stomach; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Topics: Adult; Cocaine; Crime; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Male

Drug smuggling by internal bodily concealment is a growing international problem. The management of a patient who swallowed packages containing heroin is described. The medical management, indications for surgery and the ethical dilemmas of treating patients with drugs concealed within the gastrointestinal tract are discussed.

Topics: Adult; Crime; Digestive System; Ethics, Medical; Foreign Bodies; Heroin; Humans; Illicit Drugs; Male; Stomach

Body stuffers routinely receive conservative treatment, i.e. administration of the laxative polyethylene glycol for the passage of ingested drug baggies and observation. Endoscopic baggie removal may offer a safe alternative that could result in shorter hospitalization. We aimed to compare complications, hospital stay, and final outcome in body stuffers assigned to endoscopy versus conservative treatment. This is an observational prospective study of body stuffers presenting to a clinical toxicology center in Tehran (Iran) in 2016-2019, irrespective of the drug ingested. Eligible patients had baggies in their upper gastrointestinal tract and presented without severe poisoning. Patients received either endoscopy or conservative treatment, and clinical outcomes were compared between the groups. A total of 69 patients were enrolled, with a median age of 29 years (range 18-64), among whom 1 was female (2%). Eighteen and 51 patients were endoscopically and conservatively managed, respectively. Drugs most commonly ingested were heroin in endoscopy patients (8/18 cases; 44%) and methamphetamine in the conservative group (28/51 cases; 55%). Endoscopy patients had a shorter hospital stay (median 1.5 vs. 2 days, P = 0.018). In the conservative group, one patient died, and the rate of complications was significantly higher, with more patients experiencing side effects (OR = 1.4, 95% CI = 1.2, 1.7) and requiring intubation (OR = 1.3, 95% CI = 1.1, 1.5). Endoscopic retrieval was associated with fewer complications and shorter hospitalization. Endoscopy may be a safe treatment for body stuffers without severe poisoning on presentation.

Topics: Adolescent; Adult; Body Packing; Endoscopy, Gastrointestinal; Female; Foreign Bodies; Heroin; Humans; Iran; Length of Stay; Male; Methamphetamine; Middle Aged; Prospective Studies

Topics: Administration, Intravenous; Adult; Digestive System; Drug Overdose; Foreign Bodies; Heroin; Humans; Iran; Male; Naloxone; Narcotic Antagonists; Radiography, Abdominal; Therapeutic Irrigation

Drug addiction is an important medical and social problem. "Body packing" is frequently used for concealed transportation of illegal drugs. The drug is packed in small plastic packages and swallowed or placed into body cavities, such as the rectum or the vagina. Another aspect is "body stuffing," in which the drug package is usually hastily swallowed in order to avoid arrest. Presently described is case of a body stuffer who ingested a package of heroin and was successfully treated with upper gastrointestinal endoscopy. Upper gastrointestinal endoscopy is a safe alternative therapeutic option in body stuffers in selected cases.

Topics: Adult; Drug Trafficking; Foreign Bodies; Gastroscopy; Heroin; Humans; Male; Stomach

Trafficking and sale of narcotics frequently involves the intra-abdominal transport of large quantities of drugs, usually cocaine or heroin ("body packing"), or, when there is a risk of being arrested, the oral ingestion of minor quantities of narcotics dedicated for immediate resale ("body stuffing"). This study aimed to describe the characteristics, complications and medical follow through of 132 cases of body packing (n = 36), cases of body stuffing (n = 83) or mixed cases (n = 13), referred by the authorities to our emergency department over the course of 12 years. Analysis of these 132 cases did not reveal any intra-abdominal rupture or leak of the packaging, or any case of acute intoxication. Nevertheless, a surgical intervention was required in three of the body packers (2.3%) owing to stasis of the packages inside the stomach. The mean length of stay was longer when the packets were located in the stomach at time of diagnosis than when they were lower in the gastrointestinal tract (61.9 vs 43.8 hours, respectively), but this was not statistically significant (p = 0.13). Length of stay was not associated with the presence of (nonspecific) symptoms or the total number of packs ingested. In conclusion, the study of this cohort of 132 body packers and body stuffers permits us to state that the medical management of these patients is rarely associated with serious complications, and that their length of stay is generally long, averaging 2 days before complete elimination of the drug packages.

Topics: Adult; Body Packing; Cocaine; Drug Trafficking; Emergency Service, Hospital; Female; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Male; Stomach

To investigate the dual-energy CT behavior of cocaine and heroin and of typical adulterants, and to evaluate the elemental composition of pure cocaine and heroin compared with cocaine and heroin in bodypacks.. Pure heroin and pure synthetic cocaine samples, eight different adulterants, and in each case ten different bodypacks containing cocaine or heroin, were imaged at 80, 100, 120, and 140 kVp in a dual source CT system at two different degrees of compression. Two radiologists, blinded to the samples, measured the attenuation. The dual-energy index (DEI) was calculated. We performed atomic mass spectrometry for the elemental analysis of pure cocaine, pure heroin, and heroin and cocaine in bodypacks, and 140 kVp in a dual-source CT system.. Inter- and intra-observer agreement for attenuation measurements was good (r = 0.61-0.72; p < 0.01). The cocaine bodypacks had a positive DEI of 0.029, while the pure drugs and the heroin bodypacks had a negative DEI (-0.051 to -0.027). Levamisole was the only substance which expressed a positive DEI of 0.011, while the remaining adulterants had negative DEIs ranging between -0.015 and -0.215. Atomic mass spectrometry revealed a concentration of tin in the cocaine bodypack that was 67 times higher than in the pure synthetic cocaine sample.. The different DEIs of bodypacks containing cocaine and heroin allow them to be distinguished with dual-energy CT. Although the material properties of pure cocaine, pure heroin, or common drug extenders do not explain the differences in DEI, tin contamination during illicit natural cocaine production may be a possible explanation.

Topics: Cocaine; Drug Contamination; Drug Trafficking; Foreign Bodies; Heroin; Humans; Mass Spectrometry; Multidetector Computed Tomography; Observer Variation; Reproducibility of Results

Topics: Adult; Crime; Foreign Bodies; Heroin; Humans; Illicit Drugs; Male; Stomach; Tomography, X-Ray Computed

Body packing represents the concealment of illegal substances in a person's body with the aim of smuggling. "Body packers" either swallow drug-filled packets or introduce drug-filled packets into their bodies rectally or vaginally with the purpose of concealing them. The three main smuggled drugs are cocaine, heroin and cannabis products. Body packing represents a serious risk of acute narcotic toxicity from drug exposure, intestinal obstruction owing to pellet impaction and bowel perforation with consequent abdominal sepsis. A suspected body packer is generally admitted to hospital to perform imaging investigations and confirm the presence of drugs in his/her body. Radiological imaging methods are essential to diagnose body packing and to detect potential complications. Increasing sophistication of traffickers and improvements in packaging add to the detection difficulty. Radiologists should be aware of the appearance of drug packets in a range of imaging modalities. This article informs physicians about the challenging aspects of body packing, its background and medicolegal issues, what imaging methods can be used and what criteria are necessary to perform a correct diagnosis.

Topics: Adult; Bandages; Cocaine; Diagnostic Imaging; Drug Trafficking; Female; Foreign Bodies; Heroin; Hospitalization; Humans; Illicit Drugs; Intestinal Obstruction; Intestinal Perforation; Intestines; Male; Tomography, X-Ray Computed; Vagina

To evaluate if heroin and cocaine can be distinguished using dual-energy CT.. Twenty samples of heroin and cocaine at different concentrations and standardized compression (SC) were scanned in dual-energy mode on a newest generation Dual Energy 64-row MDCT scanner. CT number, spectral graphs, and dual-energy index (DEI) were evaluated. Results were prospectively tested on six original samples from a body packer. Wilcoxon's test was used for statistical evaluation.. Values are given as median and range. Under SC, the CT number of cocaine samples (-29.87 Hounsfield unit (HU) [-125.85; 16.16 HU]) was higher than the CT number of heroin samples (-184.37 HU [-199.81; -159.25 HU]; p < 0.01). Slope of spectral curves for cocaine was -2.36 HU/keV [-7.15; -0.67 HU/keV], and for heroin, 1.75 HU/keV [1.28; 2.5 HU/keV] (p < 0.01). DEI was 0.0352 [0.0081; 0.0528] for cocaine and significantly higher than for heroin samples (-0.0127 [-0.0097; -0.0159]; p < 0.001). While CT number was inconclusive, all six original packs were correctly classified after evaluation of the spectral curve and DEI. In contrast to the CT number, slope of the spectral curve and DEI were independent of concentration and compression.. The slope of the spectral curve and the DEI from dual-energy CT data can be used to distinguish heroin and cocaine in vitro; these results are independent of compression and concentration in the measured range.

Topics: Cocaine; Crime; Drug Contamination; Foreign Bodies; Heroin; Humans; Image Processing, Computer-Assisted; Levamisole; Multidetector Computed Tomography; Narcotics; Prospective Studies

We report a case of death due to heroin leakage in a body packer, attempting to smuggle the drug by concealing it in his gastro-intestinal tract. The body was recovered 3-5 days of incidence that was confirmed by autopsy. Fifty pellets (packages) were recovered from the body, 42 identical oval shaped "egg" packages were found in the stomach out of which two were damaged, 6 in small intestine, 2 in large intestine. The total weight of the powder was 267 g. Toxicological analysis of the powder samples from the damaged package and other 48 packages was performed and was found positive for heroin, caffeine and codeine. The main pathological findings at autopsy were pulmonary and cerebral edema. This case illustrates the challenges in postmortem evaluation of narcotic fatalities and the need to consider factors such as ante-mortem history, thorough post mortem examination, toxicology results and photography in forensic diagnosis. This case is unique in the sense that cause of death was intoxication caused by leakage of heroin from damaged packages detected at autopsy and demonstrates that body packing is an existing problem in India.

Topics: Adult; Brain Edema; Crime; Drug Packaging; Foreign Bodies; Forensic Pathology; Heroin; Humans; India; Intestine, Large; Intestine, Small; Male; Narcotics; Stomach

'Mules' or body packers are people who transport illegal drugs by packet ingestion into the gastrointestinal tract. These people are otherwise healthy and their management should maintain minimal morbidity. In this study, experience with body packers is presented and an algorithm for conservative and surgical management is provided.. The clinical patient database for all body packer admissions at Mary Immaculate Hospital of the Caritas Health Care Inc. from 1993 to 2005 was interrogated. 56 patients (4.5%) required admission out of a total of 1250 subjects confirmed to be body packers and apprehended by United State Customs officials at JFK International Airport, New York. The retrieved patient data were analysed retrospectively.. 70% of the body packers were men, with a male to female ratio of 2.8 to 1. The mean age was 33 years and 52% were from Columbia. Heroin was the most common illegally transported substance (73%). 25 patients (45%) required surgical intervention, whereas 31 patients (55%) were successfully managed conservatively. Indications for intervention included: bowel obstruction, packet rupture/toxicity, and delayed progression of packet transit on conservative management. Multiple intraoperative manoeuvres were used to remove the foreign bodies: gastrotomy, enterotomy and colotomy. Wound infection was the most common complication and is associated with distal enterotomy and colotomy.. Men were more likely to present as body packers than women. Proximal enterotomies are preferred and multiple enterotomies should be avoided. A confirmatory radiological study is needed to demonstrate complete clearance of packets. A systematic protocol for the management of body packers results in minimal morbidity and no mortality.

Topics: Adolescent; Adult; Algorithms; Clinical Protocols; Cocaine; Crime; Drug Packaging; Female; Foreign Bodies; Heroin; Humans; Illicit Drugs; Male; Retrospective Studies; Transportation; Young Adult

Topics: Adult; Crime; Foreign Bodies; Germany; Heroin; Humans; Internationality; Intestinal Obstruction; Male; Netherlands; Radiography; Rectum

To determine if heroin body packing has occurred using computed tomography (CT), and to evaluate the role of CT in screening such cases.. We collected 158 cases of suspected drug packers' imaging materials (all underwent CT, 42 cases were imaged using plain x-ray film) from September 5, 2005 to April 23, 2008. Abdominal-pelvic CT appearances (shape, size, number, location and density) and abdominal plain x-ray film manifestations were retrospectively observed for those who were finally confirmed as heroin body packers through the passing of evacuated drug packets.. Among 158 cases of suspected drug packers in our study, 124 cases were finally diagnosed as heroin body packers. This was consistent with the CT results. However, there were 2 false-negative cases of abdominal imaging taken with plain x-ray film. All of the evacuated heroin body packets were produced mechanically. CT and plain film characteristic findings included the presence of uniform shape, varied density, and well-defined round or ovoid intra-luminal foreign-body shadows arranged closely along the gastrointestinal (GI) tract and/or vagina. We also found that the "air-ring sign" and "onion sign" were valuable characteristics that were seen on the CT scan, which helped to positively confirm the detection of heroin packets.. Heroin body packing has clearly defined diagnostic features that can be seen with CT. Furthermore, conventional abdominal-pelvic CT is the imaging modality of choice in the evaluation of suspected body packers.

Topics: Female; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Vagina

Topics: Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Tomography, X-Ray Computed

Topics: Colon; Foreign Bodies; Heroin; Humans; Male; Middle Aged; Miosis; Narcotics; Radiography; Travel; Unconsciousness

Topics: Colon; Female; Foreign Bodies; Heroin; Humans; Middle Aged; Narcotics; Tomography, X-Ray Computed

Topics: Arm; Foreign Bodies; Heroin; Humans; Male; Middle Aged; Neck; Pericardial Effusion; Radiography; Substance Abuse, Intravenous; Treatment Outcome

In the UK, the prevalence of drug misuse has risen in the last decade. Otorhinolaryngological surgeons need to be aware that small amounts of illegal substances, such as heroin, cannabis and cocaine, may be hidden in the external auditory meatus. We report, for the first time, concealment of heroin in the external auditory meatus. The medico-legal and ethical considerations are also discussed.

Topics: Adult; Ear Canal; Earache; Foreign Bodies; Heroin; Humans; Male; Narcotics; United Kingdom

"Body packing" of illegal drugs has increased in the last decades, and with it our experience in treating these patients, yet no clear guidelines for surgical treatment are available. We examined the characteristics and outcomes of patients who required surgical intervention.. Charts of all patients who underwent surgery at our institution for ingested drug packets between January 1990 and January 2005 were reviewed. Patients were identified by a pre-existing list of names collected prospectively and by admission codes. Reviewed parameters included presentation, method of diagnosis, indication for surgery, procedure, and patient outcome.. Twenty-five patients were identified, for whom charts were available for review. Main indications for surgery were drug toxicity and small bowel obstruction. Most packets were retrieved using a combination of milking and multiple enterotomies. A high rate (40%) of postoperative wound infection was found. The incidence of wound infection correlated significantly with the number of enterotomies.. Surgical intervention for body packing remains the treatment for a minority of these patients. Patients should be placed in lithotomy to facilitate the exposure of the entire gastrointestinal tract, and to allow milking of the packets and their possible retrieval through the anus. The number of enterotomies should be minimized in order to reduce the risk of wound infection. If multiple enterotomies are used, the surgeon should consider leaving the wound open for delayed closure.

Topics: Adolescent; Adult; Cocaine; Cross-Sectional Studies; Deglutition; Enterostomy; Female; Foreign Bodies; Foreign-Body Migration; Gastrostomy; Heroin; Humans; Illicit Drugs; Intestinal Obstruction; Length of Stay; Male; Middle Aged; New York; Postoperative Complications; Reoperation; Retrospective Studies; Surgical Wound Infection; Tomography, X-Ray Computed

A body packer is an important means of drug trafficking. While drug packets are inside the body, they can leak or rupture causing acute substance toxicity. Most of the reports of body packer syndrome have come from Europe and North America, which are destination targets. In the present study, the authors reported two cases of fatal heroin body packers from the northern part of Thailand. Both cases were foreign tourists who came to Chiang Mai and stayed in a hotel or a guesthouse room in which the deaths occurred. The autopsy findings revealed rupturing of heroin packages in the stomach. The packaging used in both cases was not sophisticated. The powder was packed inside condoms without extra covering, as observed in some other professional packers. The amount of heroin transported was about 30-50 gm. The purity of heroin in this powder was about 50-90%. Their destinations were their home countries and not directly to Europe or North America. Deaths occurred just prior to their return. The cause of death was a heroin overdose. A significant level of heroin metabolites, 6-MAM and morphine were detected in the blood and urine.

Topics: Adult; Condoms; Crime; Drug Overdose; Drug Packaging; Fatal Outcome; Foreign Bodies; Gastric Mucosa; Heroin; Humans; Male; Morphine Derivatives; Narcotics; Thailand; Transients and Migrants

We report a case of drug smuggling by internal concealment of heroin in the oesophagus. We review the literature and discuss presentation and management highlighting the need to maintain an awareness of "body packer syndrome" in the differential diagnosis of ingested foreign bodies.

Topics: Adult; Crime; Deglutition Disorders; Esophagoscopy; Esophagus; Foreign Bodies; Heroin; Humans; Male; Radiography

Topics: Abdominal Pain; Adult; Deglutition; Drug Packaging; Emergencies; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Male; Poisoning; Radiography, Thoracic; Sleep Stages; Tomography, X-Ray Computed

Topics: Adult; Drug Overdose; Emergency Medicine; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Male; Naloxone; Radiography; Treatment Outcome; United States

This is a collaborative piece of work undertaken between the PCA and a Principal FME. The study is based on 16 cases of internal drug concealment drawn from 43 drug-related deaths in custody in England and Wales between 1997 and 2002. These data are supplemented by three case studies from a county force involving non-fatal drug concealment to illustrate practical custody issues. The majority of the 16 deaths were white (n = 12) and male (n = 13) with a mean age of 34 years. In half of the cases, the deceased was known or believed to have concealed drugs orally at the point of initial contact with police. In 4/16 cases, the individual first showed signs of medical distress in a public place, a further 4 collapsed on arrival at the police station and two more detainees were subsequently found collapsed in their cell. Drug toxicity was the most common cause of death (10/16). In 5 cases death was caused by airway obstruction by swallowed packages. Both cocaine (14/16) and cannabis (8/16) traces were found in post-mortem samples. The report emphasises the need for a safety first approach.

Topics: Adolescent; Adult; Airway Obstruction; Amphetamines; Cannabinoids; Cocaine; Crime; Deglutition; Dopamine Uptake Inhibitors; Drug Packaging; Female; Foreign Bodies; Forensic Medicine; Hallucinogens; Heroin; Humans; Hypoxia; Male; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Police; Prisoners; Substance-Related Disorders

Body packing is a distinct method of drug smuggling. Surgeons and intensive care specialists will be confronted with body packers when packets do not pass spontaneously and rupture, causing drug toxicity.. We report of a 32-year-old Liberian male who presented with abdominal complaints and anxiety after having ingested 50 cocaine-containing packets of which 49 had passed the natural route in the previous days. X-ray of his abdomen showed a structure possibly compatible with a packet in or projected over the stomach. We decided to transfer the patient to the operation theatre for surgical removal via gastrotomy. However, no packet was found. During his first day in the intensive care unit he did not regain consciousness. Repeated urine analyses for cocaine were negative. After one day he deteriorated: he needed circulatory support because of hypotension, without signs of sepsis. Repeated surgery revealed no packet. In the end he turned out not to be suffering from cocaine intoxication.. When confronted with a case of body packing in which packets do not pass spontaneously and produce bowel obstruction or in which badly wrapped packets rupture, causing drug toxicity, it is of utmost importance to establish the nature of the packet's content.

Topics: Adult; Asparagus Plant; Cocaine; Daucus carota; Foreign Bodies; Heroin; Humans; Male; Poisoning; Stomach; Tomography, X-Ray Computed

Body packing is a distinct method for smuggling drugs. What radiologists need to know is discussed in this pictorial review. Radiologists are confronted with diagnostic imaging of body packers because of two main reasons: complications of body packing and identifying drug packets within the gastrointestinal tract. The standard examination used is plain X-ray of the abdomen in an upright and a supine position. Computed tomography is occasionally used but nevertheless described as a very accurate diagnostic tool. Ultrasound and MR imaging do not play an important role in that field. Depending on the purity of the drug, three different forms of attenuation have been described: hashish is denser than stool; cocaine appears similar to stool; and heroin has a gaseous transparence. The packets are of a round to oval form, usually of a particular uniformity and rarely confused with scybala if arranged like a pearl chain; therefore, plain X-ray is the method of choice to detect drug-filled packets within the gastrointestinal tract of body packers.

Topics: Cannabis; Cocaine; Crime; Diagnostic Imaging; Digestive System; Female; Foreign Bodies; Heroin; Humans; Illicit Drugs; Male; Radiography

Topics: Abdominal Pain; Adult; Crime; Drug Overdose; Foreign Bodies; Heroin; Humans; Male; Narcotics; Radiography; Sleep Stages; Stomach

Recent events in the United States have led to increased security at national borders, resulting in an unexpected increase in drug seizures. In response, drug smugglers may begin using children as couriers, including using them as "body packers.". To look at the occurrence of body packing, the concealing of contraband within the human body, which is well documented in adults, in the pediatric literature.. Two cases of pediatric body packing, in boys aged 16 years and 12 years. Patient 1, a 16-year-old boy, presented with findings consistent with opioid intoxication after arriving in the United States on a transcontinental flight. His mental status improved after he received naloxone hydrochloride, and he subsequently confessed to body packing heroin. He was treated with a naloxone infusion and aggressive gastrointestinal decontamination. He ultimately passed 53 packets of heroin, one of which had ruptured. He recovered uneventfully. Patient 2, a 12-year-old boy, presented to the emergency department with rectal bleeding. He had recently arrived in the United States from Europe, and he confessed to body packing heroin. He was treated with whole-bowel irrigation and activated charcoal, and he subsequently passed 84 packets. He also recovered uneventfully.. We report the first 2 cases of body packing in the pediatric literature and review the diagnosis and management of this clinical entity. Pediatricians should be aware that body packing, regrettably, is not confined to the adult population.

Topics: Adolescent; Charcoal; Child; Crime; Digestive System; Drug Overdose; Foreign Bodies; Heroin; Humans; Male; Naloxone; Narcotic Antagonists; Narcotics; Radiography, Abdominal; Therapeutic Irrigation; Tomography, X-Ray Computed

Topics: Adult; Cocaine; Colon, Sigmoid; Drug and Narcotic Control; Foreign Bodies; Germany; Heroin; Humans; Male; Police; Radiography; Rectum

A 28-year-old healthy man collapsed while being arrested by the police for alleged possession of heroin and was found dead on admission to the hospital. Autopsy revealed complete occlusion of the laryngeal opening by a cellophane bag containing 24 packets of heroin powder.

Topics: Adult; Airway Obstruction; Fatal Outcome; Foreign Bodies; Forensic Medicine; Heroin; Humans; Illicit Drugs; Larynx; Law Enforcement; Male; Product Packaging

Two patients were admitted to the emergency service of Haseki Education and Research Hospital due to ingestion of narcotic filled bags. Incomplete mechanical bowel obstruction developed in one of them. Both patients were treated conservatively with cleansing enema and were discharged from the hospital without any complication. We present clinical follow-up of these patients with literature review.

Topics: Adult; Aged; Cocaine; Diagnosis, Differential; Female; Foreign Bodies; Heroin; Humans; Illicit Drugs; Intestinal Obstruction; Male; Radiography

Topics: Adult; Calcinosis; Crime; Diagnosis, Differential; False Positive Reactions; Foreign Bodies; Heroin; Humans; Intestines; Male; Radiography; Sensitivity and Specificity

Topics: Adult; Foreign Bodies; Heroin; Humans; Intestinal Obstruction; Intestine, Small; Male; Tomography, X-Ray Computed

The current recommendations for body-packers are based on packet content, the presence of drug toxicity, or of bowel obstruction. Asymptomatic patients are usually treated with activated charcoal and whole bowel irrigation (WBI). Surgical removal of packets is advocated in symptomatic cocaine body-packers and in those with bowel obstruction. Currently, surgery is regarded as definitive. However, we report 2 body-packers who show the limitations of this technique. These cases show the importance of confirming the absence of drug packets in the gastrointestinal (GI) tract as the definitive end-point in the treatment of body-packers.

Topics: Adult; Cocaine; Female; Foreign Bodies; Heroin; Humans; Intestinal Obstruction; Male; Radiography; Reoperation

Drug smuggling by intra-abdominal concealment, so called "body packing," has recently increased, even in Japan. Because of fatal drug intoxication and other adverse side effects, it is important to make a radiological diagnosis of body packers as soon as possible. A retrospective analysis of the images of plain abdominal radiography, computed tomography (CT) and ultrasound (US) was performed in twenty-three body packers to evaluate the imaging characteristics of three drugs (cannabis, cocaine and heroin). Cannabis (16 patients) and cocaine (5 patients) packages were demonstrated as well-demarcated rectangular-shaped high-density shadows surrounded by gas halo ("double condom sign") in abdominal plain radiographs and CT. Heroin packages (2 patients) were demonstrated as obscure shadows and were difficult to identify on plain radiographs, because they resembled stool masses. US was performed in one cannabis patient because of the refusal of radiological examination, and packages were demonstrated as round echogenic structures with dorsal echo extinctions. In conclusion, abdominal plain radiography, CT and US represent valuable diagnostic modalities in the assessment of body packers.

Topics: Abdomen; Adult; Cannabis; Cocaine; Crime; Drug and Narcotic Control; Drug Packaging; Female; Foreign Bodies; Heroin; Humans; Male; Middle Aged; Radiography, Abdominal; Retrospective Studies; Tomography, X-Ray Computed; Travel; Ultrasonography

In four patients, a woman of 35 and men of 27, 38, and 22 years old, body-packer syndrome was diagnosed. Body-packer syndrome is seen in people concealing drugs in special containers within the body; this may lead to rupture with acute intoxication or to ileus. The clinical presentation can be very deceptive. An abdominal X-ray often reveals the packages. If there are no symptoms treatment is with mild laxatives, acute intoxication requires immediate laparotomy. One of the four patients died, the others recovered. Legally (Dutch law), the physician best delivers the drug to the police as a lost object, without revealing the patient's identity.

Topics: Adult; Cocaine; Constipation; Fatal Outcome; Female; Foreign Bodies; Heroin; Humans; Male; Radiography; Stomach Rupture; Syndrome

The deaths of 10 heroin body packers are reported and contrasted to those of cocaine body packers. Only one was a woman, and all were traveling to or from Colombia. Drug packets deteriorated in the gastrointestinal tract and caused the deaths of eight victims. Accomplices removed drug packets from two of these smugglers after death occurred. One died of peritonitis stemming from a small-bowel obstruction caused by the drug packets, and one died from the recreational use of heroin (nasally ingested). The heroin recovered was < or = 881 g, and the drug purity of the contraband in three cases was between 65% and 73%. Blood concentrations of morphine were < 1.0 mg/L in four victims; no morphine was detected in the smuggler who died of peritonitis. However, two victims had blood morphine concentrations of 4.4 mg/L and 6.7 mg/L, respectively, and three had morphine concentrations of 35.8, 39.4, and 52.6 mg/L, respectively. Fatal heroin body packing differs from cocaine body packing in that individuals may have extremely high drug levels in their blood and their accomplices appear to be more likely to abandon them in a remote location after attempting to remove the drug packets after death has occurred.

Topics: Adult; Crime; Digestive System; Drug and Narcotic Control; Drug Overdose; Female; Foreign Bodies; Heroin; Humans; Male; Middle Aged; Narcotics

Topics: Abdominal Pain; Acute Disease; Adult; Colon; Drug Packaging; Foreign Bodies; Heroin; Humans; Male; Narcotics; Radiography

The presentation to surgical units of patients carrying illegal drugs in the gastrointestinal tract is a frequent occurrence at hospitals sited close to international airports. Drugs, usually heroin or cocaine, are wrapped in cellophane packets or condoms. The packages are intracorporeally concealed by being swallowed or passed into the rectum. The majority of drug traffickers carrying intracorporeal drug packages do not require any medical intervention. Recent reports have suggested that these patients are best treated expectantly avoiding any operative procedures. However, the quantity of drug in any one of the ingested packets is usually above the toxic dose and acute drug toxicity, as well as bowel obstruction, can result in fatalities. We report a series of five patients who presented over a period of 2 years to a hospital close to Heathrow International Airport, London. The presentation and treatment are reviewed and the management of such 'surgical mules' discussed. We have shown that conservative treatment is appropriate providing bowel obstruction or package perforation has not occurred.

Topics: Adult; Cocaine; Crime; Digestive System; Female; Foreign Bodies; Heroin; Humans; Male; Middle Aged; Radiography

Drug smuggling by internal bodily concealment is a well-recognized international problem, particularly in view of the difficulty of its detection and the potential for large financial gains. This mode of transport can have serious medical complications, including drug intoxication--sometimes fatal--as well as intestinal obstruction by foreign bodies (FBs). We discuss a case of heroin 'bodypacking' (the ingestion of heroin filled condoms) with its resultant complications. The initial medical management and indications for surgery are discussed, and the relevant literature reviewed.

Topics: Adult; Crime; Digestive System; Foreign Bodies; Heroin; Humans; Intestinal Absorption; Male; Poisoning; Travel

Topics: Adult; Cocaine; Emergencies; Foreign Bodies; Heroin; Humans; Intestine, Small; Male; Stomach

The clinical, radiological and analytical aspects, and the complications observed in 16 cases of swallowing or insertion into the rectum of illicit drugs ("body-packing") are described. The drugs detected were heroin (6 cases), cocaine (5 cases) and cannabis (5 cases). In 15 cases abdominal plain X-rays were useful in the detection of the drug packages, their position and progression in the gastrointestinal tract and the presence of complications. The most valuable finding for radiologic diagnosis was the presence of a radiolucent halo surrounding the drug packages, or "double condom" sign, which was observed in 13/15 cases (87%). Urine analysis was positive for opiates or metabolites of cocaine in 7/9 cases (78%). One case presented acute heroin intoxication and three subjects gastric or intestinal obstruction requiring surgical treatment. In another case a packet, which had been retained in the stomach for five days, was extracted by upper gastrointestinal endoscopy using a Dormia basket with no complications.

Topics: Adult; Cannabis; Cocaine; Digestive System; Emergencies; Female; Foreign Bodies; Heroin; Humans; Illicit Drugs; Intestinal Obstruction; Male; Radiography

During the last year the number of examinations of living persons ordered by custom officers to find out if they are possibly carrying drugs inside their intestinal tract or vagina in the meaning of "Body-Packing" increased severely. In this paper the value of different diagnostic techniques is demonstrated according to experience we gained at Hannover during the last years. Principal questions of german federal law as basis of these examinations are discussed.

Topics: Diagnostic Imaging; Drug and Narcotic Control; Female; Foreign Bodies; Gastrointestinal Transit; Germany, West; Heroin; Humans; Intestines; Male

The presence of opiates and benzoylecgonine, the major metabolite of cocaine, in the urine was detected by means of enzyme immunoassay in a series of 120 smugglers who had either ingested or inserted into their rectum cocaine or heroin packaged for transportation. There was a striking relation between the presence of drugs in the urine and swallowing of drug-filled bundles (cocaine 49 of 50 cases, heroin 9 of 10). The proportion of positive results was also high in cases of rectal insertion (cocaine 2 of 2, heroin 35 of 58). In 30 cases of cocaine-packet ingestion, serial measurements showed that the accuracy of the test progressively decreased with respect to the detection of residual packets in the body. Drug detection in the urine of suspected body-packers seems to be a useful test, positive results justifying subsequent radiological investigations.

Topics: Cocaine; Crime; Evaluation Studies as Topic; Foreign Bodies; Foreign-Body Migration; Heroin; Humans; Immunoenzyme Techniques; Morphine; Radiography; Rectum

One hundred cases of intracorporeal concealment of narcotic drugs were observed over a 6-month period at the medico-judicial emergency centre of the Hotel-Dieu hospital, Paris. Twelve cases concerned dealers who had ingested packs at the time they were arrested. The other subjects had been carrying the drug in their digestive tract, rectum or vagina for transportation. The illicit drugs thus transported were cocaine in 20 cases (ingestion), heroin in 65 cases (ingestion 7, rectal or vaginal cavity 58) and cannabis in 3 cases. Packs for sale being fragile, the dealers were particularly exposed to overdosage. Their management prior to intoxication was the same as that of acute ordinary drug poisoning, i.e. washing out of the stomach. In carriers, the risk of severe poisoning was associated with ingestion. The lack of antidote makes cocaine poisoning particularly dangerous. Surgical extraction is now reserved to cases with intestinal mechanical complications and to those increasingly rarer cases of fragile transportation packs.

Topics: Adult; Cannabinoids; Cocaine; Digestive System; Drug and Narcotic Control; Drug Packaging; Emergencies; Female; Foreign Bodies; Forensic Medicine; France; Heroin; Humans; Male; Middle Aged; Radiography; Rectum; Vagina

Two patients deliberately ingested single paper packages containing heroin. These were recovered intact by induction of emesis with syrup of ipecacuanha.

Topics: Adult; Emergencies; Foreign Bodies; Heroin; Humans; Ipecac; Male; Radiography; Stomach; Substance-Related Disorders

Topics: Adult; Foreign Bodies; Heroin; Humans; Male; Stomach

We report a unique complication of intravenous drug abuse, central embolization of a needle from a peripheral site. A heroin addict dislodged a needle into the soft tissues of the forearm during self injection. Immediate surgical attempts to visualize and remove the needle were unsuccessful. On a subsequent admission, chest radiograph showed the needle in the right mid-lung field. No attempt at removal was made.

Topics: Adult; Foreign Bodies; Foreign-Body Migration; Heroin; Humans; Injections, Intravenous; Male; Needles; Pulmonary Embolism; Radiography

Topics: Abdomen; Adult; Colon; Crime; Female; Foreign Bodies; Heroin; Humans; Male; Radiography

The smuggling of illicit drugs, either swallowed or inserted into the rectum or vagina, is gaining in popularity, particularly in view of the difficulty of its detection and the potentially large financial gains. Such contraband includes heroin (especially in Western Australia), cocaine, and marijuana and its derivatives. This practice is not without complications--drug intoxication, which may be fatal, and intestinal obstruction by foreign bodies have been reported. We review the cases of "body packing" reported in the literature and those detected in Western Australia over the past two years, and describe three cases of the ingestion of heroin-filled condoms, with resultant complications.

Topics: Adult; Australia; Constipation; Crime; Esophagus; Female; Foreign Bodies; Heroin; Humans; Legislation, Drug; Male; Stomach; Travel

Topics: Adolescent; Cocaine; Digestive System; Foreign Bodies; Heroin; Humans; Male

Four cases of attempts to smuggle narcotics (marijuana, heroin, and cocaine) by swallowing a large number of drug-filled foreign bodies (condoms and capsules) and hiding them from customs authorities in the gastrointestinal canal during transit are described. This is compared with a psychiatric patient who swallowed 48 Vicks Inhalers. Drug smuggling by swallowing condoms or capsules containing narcotics is now a worldwide ethical-legal problem. It also is of therapeutic and prognostic importance as this may lead to such emergencies as mechanical obstruction, rupture of the drug-containing foreign bodies, and life-threatening intoxication of the carrier.

Topics: Adult; Cannabis; Cocaine; Crime; Digestive System; Foreign Bodies; Heroin; Humans; Illicit Drugs; Male; Pharmaceutical Preparations; Radiography

Topics: Adult; Amphetamine; Anemia, Hemolytic; Barbiturates; Biopsy; Chronic Disease; Foreign Bodies; Foreign-Body Reaction; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Liver; Liver Cirrhosis; Lung; Male; Methods; Microcirculation; Substance-Related Disorders; Tablets

Topics: Adult; Barbiturates; Female; Foreign Bodies; Heroin; Heroin Dependence; Humans; Injections; Injections, Intra-Articular; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Ischemia; Male; Muscles; Opium; Phlebography; Substance-Related Disorders; Surgical Procedures, Operative; Thrombophlebitis

Topics: Adult; Arm; Autopsy; Foreign Bodies; Granuloma; Heroin; Humans; Injections, Intravenous; Lung; Lung Diseases; Male; Tablets

Topics: Accidents, Home; Adult; Foreign Bodies; Heroin; Humans; Male; Substance-Related Disorders

Topics: Adult; Amphetamine; Barbiturates; Foreign Bodies; Granuloma; Heroin; Humans; Lung; Lung Diseases; Male; Microscopy, Electron; Pulmonary Embolism; Substance-Related Disorders