heroin and Foreign-Body-Migration

"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

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

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