heroin and Intestinal-Obstruction

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

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

"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

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; 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

Death from heroin body packing has been well described in the forensic literature. Most fatalities are due to drug leakage and consequent acute heroin toxicity. Recently, drug traffickers have become more sophisticated in their packaging, and the risk of rupture of drug packets is more remote. Though intestinal obstruction is a recognized risk of body packing, rarely has this resulted in death. We describe four cases of heroin body packing presenting to the Regional Medical Examiner Office in New Jersey. Death in three of these cases was due to intestinal obstruction, with resultant intestinal rupture and peritonitis. Toxicologic evaluation in these three cases was negative for opiates or other drugs of abuse. In one case, death was due to acute heroin toxicity, validated by toxicologic analysis. We briefly discuss the differing drug packaging found in these four cases and the ramifications of packaging as it relates to intestinal obstruction.

Topics: Adult; Cellophane; Crime; Drug Packaging; Fatal Outcome; Heroin; Humans; Intestinal Obstruction; Intestinal Perforation; Male; Middle Aged; Narcotics

We present a case of a male patient who spent several hours sitting with legs crossed and upper body bent forward after nasal insufflation of heroin (snorting). Death occurred 3 days later as a result of leg muscle necrosis and intestinal ileus with infarction. The autopsy findings, including microthrombi in small mesenteric vessels and necrosis of the leg muscles, were attributed to vascular compression due to the man's position and to metabolic processes resulting from drug ingestion.

Topics: Administration, Intranasal; Adult; Fatal Outcome; Heroin; Humans; Infarction; Intestinal Obstruction; Intestine, Small; Leg; Male; Posture

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

A patient with advanced multiple sclerosis was successfully managed for a sigmoid colectomy using spinal anaesthesia. Effective postoperative analgesia was achieved with intrathecal diamorphine administered through an indwelling intrathecal catheter, and wound infiltration with 0.25% bupivacaine.

Topics: Adult; Anesthesia, Spinal; Heroin; Humans; Injections, Spinal; Intestinal Obstruction; Male; Multiple Sclerosis; Pain, Postoperative; Sigmoid Diseases

Ingested cocaine can be a cause of severe bowel ischemia or gangrene. Two cocaine addicts who ingested large quantities of the drug developed severe abdominal symptoms and signs caused by bowel ischemia. In one patient gangrene of the bowel necessitated repeated resections and was followed, several weeks later, by death. The other patient suffered less severe ischemia and the bowel returned to normal. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal symptoms and signs. The presence of marked leukocytosis suggests bowel gangrene and demands prompt surgical intervention.

Topics: Adult; Cocaine; Colectomy; Colon; Female; Gangrene; Gastrointestinal Hemorrhage; Heroin; Humans; Ileostomy; Ileum; Intestinal Obstruction; Intestines; Ischemia; Necrosis; Substance-Related Disorders; Suicide, Attempted

Topics: Adolescent; Adult; Aged; Burns; Colon; Endotoxins; Female; Gastrointestinal Hemorrhage; Heroin; Humans; Intestinal Obstruction; Ischemia; Kidney Transplantation; Liver Cirrhosis; Liver Diseases; Lung Diseases, Parasitic; Male; Middle Aged; Mononuclear Phagocyte System; Morphine Dependence; Peritonitis; Sepsis; Shock, Septic; Transplantation, Homologous; Urinary Fistula; Urinary Tract Infections

Topics: Adrenal Cortex; Adrenal Cortex Diseases; Brain; Brain Diseases; Heroin; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestines