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Background: Body packing and body stuffing of illicit drugs have increased in recent decades. The drug contents of the packages vary from region to region, and there are controversies surrounding the diagnostic and therapeutic methods. The aim of this study was to explore the clinical presentations, diagnostic and therapeutic measures, and the subsequent clinical outcomes of drug concealment by people. Methods: A retrospective analysis was performed on data for all cases of body packing and body stuffing that were referred to a university hospital, in Isfahan, Iran, from Mar. 2013 to Feb. 2018. Results: Sixty-eight body stuffers and 18 body packers (n=86) were included in this study. Seventy-eight patients (90.7%) were male, mostly aged between 20 to 40 years. There was no significant difference between the two groups with respect to the signs and symptom, hospital stay, treatment and clinical outcomes. Heroin and crystal methamphetamine, n=52 (60%) and n=22 (25%), respectively, were the most substances detected, irrespective of the concealment method. Abdominal X-ray and CT scan tests were positive for the detection of at least one packet in each of the 94.4% of the patients. Conclusion: Heroin and crystal methamphetamine were the most common substances concealed in the bodies of the patients. Based on our findings, CT scan was more sensitive than abdominal X-ray test in the detection of illicit drug packets concealed in the patients. Close observation and whole bowel irrigation were effective therapeutic modalities in most cases. All cases were fully recovered and discharged from the hospital.

Due to the continuous improvement in packaging technique widely used for illicit drug trafficking, body packers involved in criminal activities are rarely arrested or died of chemical intoxication. A fatal case of a young body packer was presented with packages of morphine served as analgesics for clinical activities or raw material for opioids, which was seldom reported for body packing in contrast to the main illegal substances such as cocaine, heroin, and methamphetamine. A literature review regarding deaths from morphine poisoning was conducted to summarize data to support medico-legal practice. Our study provides a possible insight into the packages’ leakage or rupture of illegal substances occasionally discovered during forensic autopsy. Based on the unusual case compared with previous data, raising awareness of the drug traffic pathways of road routes would be useful for identifying possible unrecognized cases of body packing.

Background: Body packing is the concealment of illicit drugs enclosed in containers inside the body by swallowing or insertion into the rectum or vagina, usually for transportation to escape detection by customs agents. This report seeks to explore ways of establishing general definition of body packer in the Moroccan context and assess it’s possible implications on data collection and future research. Materials and Methods: This is a descriptive and analytical retrospective study of two fatal cases related to Cocaine toxicity of body packers. The deceased underwent an autopsy at Medico-legal institute of Ibn Rochd University Hospital (UHC) of Casablanca, Morocco. Cases presentation: In these index cases, 02 male youths of foreign nationality in their twenties died in Casablanca airport. The young men took ill at the airport. Abdominal CT scan subsequently performed at the hospital revealed intra-abdominal capsules in both cases. Autopsy showed 47 whitish capsules in the stomach and colon in the first case and 67 similar capsules in the small intestine in the second case. Rapid toxicology testing in the forensic laboratory confirmed the powder to be cocaine. The cause of death was secondary to acute intoxication by leakage of cocaine substances from their packaging. Conclusion: Prevention and compliance with the legislation governing drug trafficking activities, are of vital interest in reducing the incidence of youth use as vectors of drugs and mortality consequence.

Body packing is one of the common ways to traffic illicit drugs. Drug mules usually swallow or insert drugs within the gastrointestinal tract or other orifices. Detection of such drug packets has become difficult because of the constantly improving packaging techniques and the sophistication used by traffickers. Suspected obstruction or perforated hollow viscus requires employment of appropriate radiological procedures and techniques for accurate detection and precise diagnosis. A delay diagnosis and inappropriate action may carry disastrous physical consequences for the body packers. It is crucial for radiologists to acquire enough experience to deduce different types of drug packets from their imaging characteristics and to accurately guide emergency physicians and security officials. The packets are not always radiodense, therefore they can be difficult to detect on conventional abdominal radiographs. In this report, the authors illustrate 5 cases with different packaging methods and materials that give rise to radiological challenges. Keywords: Body packer, Illicit drug smuggling, Imaging modalities

Resumen El término body packer es utilizado en el ambiente hospitalario para referirnos a aquellas personas que transportan sustancias ilegales (drogas) en el tracto digestivo tras la ingesta de éstas perfectamente embaladas a modo de pequeños paquetes. El contrabando de estas sustancias utilizando a la propia persona como medio de transporte, lejos de disminuir, ha aumentado en la última década tanto en Estados Unidos como en Europa, especialmente tras los atentados del 11S, ya que las medidas de control de las fronteras por mar y aire se han intensificado. A la vez, y por la misma razón, se han mejorado los sistemas de seguridad en puertos y aeropuertos, por lo que el número de detenciones de estos individuos igualmente ha aumentado. Cualquier complicación derivada del paso de estos paquetes a través del sistema digestivo puede ser mortal (2-3% de los casos) si no se actúa de forma eficaz y efectiva, es por ello, que el facultativo debe conocer tanto el manejo como el tratamiento de estos casos, así como saber identificar los signos y síntomas que puedan hacer sospechar que dicha complicación se está produciendo. El establecimiento de un protocolo de actuación específico para estos casos es fundamental para el correcto manejo de los pacientes.

Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as “body packers”, “stuffers”, “mules” or “swallowers” and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.

Introduction Different methods are used to confiscate evidence whenever suspected body packers or body stuffers are taken into custody. Among these, controlled defecation and analysis of drug toilets from suspects has proved to be safe given that no invasive or forceful procedures are applied. Materials and methods All records of “drug toilet” evaluations done at the Hamburg Institute of Legal Medicine from January 1st 2018 to April 30th 2021 were descriptively analyzed for the individual’s age, sex, country of origin, and whether the drug toilets contained any drug “balls”, packages or containers. In case of a positive finding, the total number of balls found were recorded. Special cases are presented in detail for illustrative purposes. Results Drug toilets from 72 suspects were examined in the period under review. 98.6% (n = 71) of the suspects were males and relatively young with approximately two-thirds (62.5%, n = 45) aged 34 years or below (range 18–50 years). The majority of suspects originated from African countries (72.2%, n = 52). The typical drug balls or containers were found in 13 (18.1%) of the examined drug toilets. Conclusion Negative drug toilets might indeed indicate that the suspect had not ingested any drug packages at the time of arrest or while in custody. However, multiple excretions, voluntary delay of defecation, use of drugs to delay the excretion process or even individual differences in excretion times are possible, and therefore, a negative drug toilet should not always imply with certainty that the individual in question had not ingested any drugs.

We present a case of a 39-year-old man who was brought in by ambulance to the ED after ingesting 103 packets of cocaine prior to return to the United Kingdom (UK) from Holland. He presented with a persistent sinus tachycardia and mild abdominal pain but no evidence of peritonitis on examination. Contrast-enhanced CT showed widespread distribution of packets from the stomach to the sigmoid colon. He was taken to theater for emergency laparotomy and retrieval of the packets, which was done successfully without the need of any bowel resection. He was then discharged to police custody following a 10-day admission. This is the highest number of cocaine packets reported in the UK literature. This case report discusses the importance of a multidisciplinary approach in safely managing body packers who also present with signs of cocaine toxicity.

Background: Body packing is a frequently used method for drug trafficking. Local information about the clinical and radiological features of body packing is lacking. Objectives: To evaluate the radiological features of body packers presenting to a hospital near to the Hong Kong International Airport and to compare the radiological features of solid form versus liquid cocaine. Methods: This was a retrospective cohort study. Medical notes of 269 suspected body packers, presenting to the Accident and Emergency Department of North Lantau Hospital under the detention by the law enforcement personnel from 1st January 2015 to 28th February 2017, were reviewed. The radiological features of body packing were retrospectively evaluated. Results: Sixty-nine cases were confirmed body packers radiographically. Majority of them (81%, 56/69) were cocaine packers. Powder form cocaine (67%, 49/69) was the most popular drug packed, followed by liquid cocaine (15%, 10/69). There was a trend of increasing incidence of liquid cocaine packers. The classical ‘double condom’, ‘tic tac’ and ‘halo’ signs were present in 94%, 72.5% and 42% of cases with radiologically confirmed body packing respectively. The ‘rosette’ sign was only identified in 1 case. Three new radiological signs, the ‘bag of eggs’, ‘lucent triangle’ and ‘black crescent’ sign, were suggested to aid identification of drug packets. The classical ‘tic tac’ sign was absent in all liquid cocaine packing cases (pConclusion: Failure in detecting drug body packing may result in medicolegal consequences. Emergency physicians need to be aware of subtle radiological signs of liquid cocaine packets in the plain abdominal radiography.

Body packing is defined as the ingestion of drug packets, to conceal them during transportation. We report the case of a 63-year-old cocaine body packer, who died from an aortic dissection. He was arrested in Paris as he disembarked from a flight from Cayenne (French Guinea) and custom officers found cocaine in his suitcase. The patient admitted the ingestion of cocaine packets. He was transferred to the hospital where an initial computerized tomography scan showed hyperdense, uniformly shaped packets located in the colon. On admission, his blood pressure was elevated but he did not exhibit any other signs of adrenergic syndrome. The diagnosis of chronic hypertension unrelated to the cocaine body packing was retained. During hospitalization, 40 h after the ingestion of the cocaine packets, the patient showed acute agitation, sweat and a high blood pressure. Given the context, an emergency thoraco-abdominal-pelvic CT-scan was carried out to rule out a cocaine leakage. None of the packets showed evidence of leakage but the CT-scan assessed an aortic dissection extending to the entire descending aorta. Despite intensive care, the patient passed away on the fifth day. This aortic dissection could have appeared spontaneously in a patient with significant atherosclerosis lesions of the aortic network. Nevertheless, we believe that cocaine impregnation causing high blood pressure might have played a role in the aortic dissection, even without a cocaine leakage from the packets. This case highlights the need to achieve an effective control of the blood pressure in cocaine body packers.

Background: The incidence of smuggling and illegal transport of substances by internal concealment, also known as body packing, is increasing. The clinical approach to body packers has changed significantly over the past two decades. In addition, the mortality of body packers is an important issue in patient management. The purpose of the current study is to determine the statistics and mortality related to body packing. Methods: In this cross-sectional study, all body packer patients who referred to Loghman Hakim hospital were evaluated from 2010 to 2017. Demographic characteristics, findings of clinical imaging, treatment, and outcome of the patients were recorded. The data were analyzed using SPSS version 21. Results: A total of 303 patients were enrolled in the study after the diagnosis of body packing by abdominal CT scanning without contrast. Conservative treatment including whole bowel irrigation (WBI) accompanied by close monitoring was done for 78% (n = 236) of patients; moreover, 26 patients (8.5%) underwent surgery after WBI, and 41 patients (13.5%) underwent surgery without bowel irrigation. Mortality was observed in eight patients (2.7%) five of whom (62.5%) died before surgery and had the clinical manifestation of crystal (methamphetamine) and cannabis toxicity. Furthermore, three patients (37.5%) died due to the complications of surgery such as gastrointestinal leakage of an abdominal abscess. Conclusion: Conservative treatment seems to be better for the management of body packers. In addition, it is necessary to monitor patients for possible signs and symptoms of intoxication and gastrointestinal obstruction.

Objetivo: Describir el plan de cuidados de enfermería para body packers en los tres niveles de atención. Metodología: Investigación sistemática, realizando una búsqueda en bases de datos por medio de ecuaciones de búsqueda creadas en español, inglés y portugués. Se seleccionaron y revisaron artículos científicos publicados desde el año 2001 al 2019 que presentarán información pertinente sobre la atención de enfermería en personas body packers. Resultados: Se seleccionaron 27 artículos utilizados como unidad de análisis, consolidándolos en una matriz de 8 temáticas: características de los transportadores, drogas transportadas, examen físico, síntomas, tratamiento clínico, complicaciones clínicas, medios diagnósticos y aspectos éticos de los profesionales de la salud, identificando las características definitorias que fueron implementadas para desarrollar un plan de atención de enfermería según la taxonomía NANDA. Conclusiones: Los resultados arrojados por la literatura se basan en reporte de casos y revisión bibliográfica, que no aportan un alto nivel de recomendación, ni de evidencia. Por otro lado, la literatura no reporta información desde el campo de enfermería si no va más enfocada a las imágenes diagnósticas implementadas para reconocer el transporte de las sustancias ilícitas. Objective: Describe the nursing care plan for body packers in the three levels of care. Methodology: Systematic research, performing a search in databases through search equations created in Spanish, English and Portuguese. Scientific articles published from 2001 to 2019 were selected and reviewed, which will present pertinent information on nursing care in body packers. Results: We selected 27 articles used as a unit of analysis, consolidating them in a matrix of 8 topics: characteristics of transporters, drugs transported, physical examination, symptoms, clinical treatment, clinical complications, diagnostic means and ethical aspects of health professionals , identifying the defining characteristics that were implemented to develop a nursing care plan according to the NANDA taxonomy. Conclusions: The results of the literature are based on case reports and literature reviews, which do not provide a high level of recommendation or evidence. On the other hand, the literature does not report information from the nursing field if it is not focused more on the diagnostic images implemented to recognize the transport of illicit substances. Pregrado Enfermero(a)

Intentional body dismemberment is usually associated with homicides. This chapter presents two unusual cases of postmortem body dismemberment following accidental deaths. The cases presented were accidental drug overdoses associated with body packing. Body packers are people who ingest packets of illicit drugs or insert them into body cavities for purposes of smuggling. Fatalities occur when these ingested packets accidentally leak or rupture. In the cases presented, accomplices cut the decedent’s bodies to remove the drugs and then dismembered the bodies for disposal. Annual trends of body packer fatalities in New York City are also presented.

“Body packers” are persons who voluntarily or through coercion, swallow or insert drug-filled packets into body cavity, generally in an attempt to smuggle them across secure borders. The drugs most often involved in body packing are heroin and cocaine. Body packers can present in the emergency department as a result of ruptured drug packets, bowel obstruction, or for medicolegal purposes. Suspected cases are diagnosed with X-ray and computed tomography scan of the abdomen. Symptomatic patients require urgent removal of packets. We present a case of foreign national male in whom a drug packet got ruptured and 49 other packets were retrieved with help of laxatives and manual evacuation.

Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.

OBJECTIVE: The objective of this study was to systematically evaluate the accuracy of abdominal CT performed at different radiation dose levels for the detection of body packs in human cadavers, in comparison with the accuracy of abdominal radiography. MATERIALS AND METHODS: In this study, differing numbers of body packs (range, 0-20) were placed in the alimentary tract of human cadavers and then underwent imaging with abdominal radiography and with CT performed at different radiation dose levels (ranging from the standard abdominal CT dose to the technical minimum dose). Depiction of body packs on abdominal radiographs and on each CT scan was assessed by two independent blinded radiologists, and the accuracy of detection of body packs was calculated. The radiation dose associated with abdominal radiography was measured, and the effective radiation dose associated with CT was estimated. RESULTS: The mean (± SD) effective radiation dose for abdominal radiography was 1.4 ± 0.3 mSv, whereas the mean effective dose of CT ranged from 0.1 to 9.6 mSv. Interobserver agreement for body pack detection was moderate (κ = 0.51) for abdominal radiography and good (κ = 0.72-0.85) for CT. In a per-body pack analysis, abdominal radiography depicted 42% of the body packs with a sensitivity of 71% and a specificity of 100%. When performed at radiation dose levels of 0.6 mSv or greater, CT correctly detected all body packs. In per-person analysis, the sensitivity and specificity of CT for the correct detection of at least one body pack per cadaver was 100% for all radiation dose levels. CONCLUSION: CT performed at a dose of 0.6 mSv can be used for the detection of body packs. With a sensitivity and specificity of 100%, CT is superior to abdominal radiography in terms of reliability, associated radiation dose, and accuracy of detection.

Drug trafficking is an international problem. Over years it has increased in prevalence and concealment methods. Body packers swallow wrapped packets of illicit drugs, mainly cocaine and heroin and try to conceal them from security personnel. They present to physicians either as body packer syndrome with symptoms of intoxication or asymptomatically on suspicion of drug concealment, for observation. We report a case of middle aged unknown male, found in comatose state on road side by Delhi police (India), brought to our emergency without any signs of injury. Initially organophosphate toxidrome was suspected, later confirmed to be opiod toxidrome with internal concealment of many balloons (of polythene) wrapped packets of heroin. On failure of conservative removal, he underwent laparotomy with complete removal of all the packets. He was discharged in stable condition and handed over to the police. This is the first case report of live heroin body packer syndrome from India.

We evaluated the added value of lung window in non-contrast computed tomography (CT) of suspected body packers or stuffers. Forty suspected drug mules who were referred to our tertiary toxicology center were included. The final diagnosis of drug mule was based on the detection of packs in stool examination or surgery. Non-contrast CT scans were retrospectively interpreted by two blinded radiologists in consensus before and after reviewing the lung window images. The diagnostic performance of abdominal window scans alone and scans in both abdominal and lung windows were subsequently compared. Seven body packers and 21 body stuffers were identified. The sensitivity, negative predictive value (NPV), and diagnostic accuracy of scans in detection of drug mules (either drug packers or stuffers) raised from 60.7, 52.1, and 72.5 to 64.2, 54.5, and 75.0 %, respectively, with a more number of packs being detected (114 vs. 105 packs). In the body packers group, the diagnostic performance of both abdominal windows scans and combined abdominal and lung windows scans were 100 %. In the body stuffers group, the sensitivity, NPV, and diagnostic accuracy of scans increased from 47.6, 52.1, and 55.0 to 52.3, 54.5, and 57.5 %, respectively, after the addition of lung windows. Reviewing the lung window on non-contrast abdominal CT can be helpful in detection of drug mules.

Background In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006–2016. Methodology This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers. Results We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking —Yunnan, Sichuan, and Myanmar— and three potential authorities— Guangdong, Xinjiang, and Sichuan—which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment. Conclusion By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.

Managing body packers and stuffers is a challenge to emergency physicians, stuffers in particular, as there is no systematic approach to their treatment. The aim of this study was therefore to review all available literature on body stuffing and propose a guide to manage these patients. We searched Medline/PubMed, Google Scholar, and Scopus for published work on body stuffers using key words “body stuffer”, “body stuffing”, “poisoning”, “toxicity”, and “treatment” without a time limit and retrieved 290 articles, of which 61 remained after exclusion of those on “body packers” and repetitive documents. This review article evaluates and summarises the information gathered from them. The main step in body stuffer management is observation to make sure that they have passed all the swallowed packages of drugs of abuse. In some cases, imaging can be quite useful. Diagnostic pitfalls may be avoided with abdominopelvic CT without contrast, which is probably the best diagnostic method to determine the presence and the number of packages in these patients. Treatment should be specific for each group of drugs, whether it is opioids, cocaine, or amphetamine. Surgical interventions are indicated for obstruction of the intestines or package rupture. Legal precautions should be taken because of the legal complexity of body stuffing cases., Medicinska obrada osoba koje su progutale ili u tijelu skrivaju pakete s opojnim sredstvima veliki je izazov liječnicima na odjelu hitne pomoći. Razlikuju se osobe koje su pakete (vrećice, ampule) progutali s namjerom da ih prokrijumčare (tzv. mule ili body packers) i one koje su progutale pakiranja u strahu da ne budu uhvaćeni s drogom (tzv. body stuffers). U potonjem je slučaju riječ o manjim količinama, ali mnogo slabije upakiranih tvari, zbog čega može doći do puknuća omota, curenja njegova sadržaja u tijelo, predoziranja i smrti. Svrha je ovoga istraživanja bila napraviti pregled dostupne literature upravo o toj rizičnoj skupini i predložiti standardnu obradu takvih pacijenata. Za pretragu su korišteni web pretraživači znanstvenih radova Medline/Pubmed, Google Scholar i Scopus pomoću ključnih riječi “body stuffer”, “body stuffing”, “poisoning” (trovanje), “toxicity” (toksičnost) i “treatment” (liječenje) bez vremenskog ograničenja objavljivanja. Pretraga je izbacila 290 članaka, od kojih su izuzeti oni koji se odnose na body packers i oni koji se ponavljaju. Stoga se ovaj pregledni rad u konačnici oslanja na korisne informacije dobivene iz 61 relevantnog članka o toj temi. Najvažniji je korak pri obradi body stuffera promatranje i praćenje, kako bismo bili sigurni da su izbacili iz tijela sve progutane pakete s opojnim drogama. U pojedinim slučajevima tehnike snimanja mogu se pokazati veoma korisnima. Dijagnostičke zamke koje obično daju lažno negativne rezultate mogu se izbjeći beskontrastnom kompjutorskom tomografijom (CT-om) područja trbuha i zdjelice, kao ponajboljom metodom za utvrđivanje postojanja i broja paketića u tih pacijenata. Liječenje treba biti prilagođeno vrsti droge, budući da opioidi, kokain odnosno amfetamin, zahtijevaju različitu obradu. Kirurške su intervencije indicirane kod opstrukcije crijeva ili puknuća paketa. Također valja imati na umu zakonske implikacije zbog kaznene naravi skrivanja droga u tijelu.

Highlights • The incidence of body packing of illicit drugs is on the rise. • Radiography is crucial in the diagnosis of body packing. • Arrhythmia, seizures, and respiratory depression can complicate perioperative care. • Surgical intervention is necessary for those with signs and symptoms of bowel obstruction or drug overdose., Introduction Body packing is the use of intra-corporeal packages of illicit drugs for the purpose of smuggling, usually through customs. Clinical cases and experience with body packers has increased since the first report appeared in 1971. These cases remain an uncommon cause of acute drug toxicity and/or bowel obstruction. Presentation of case A 23 year-old man was brought to the emergency department with seizures. CT imaging revealed numerous intestinal foreign bodies, suspicious for body packing. The patient was stabilized and taken emergently to the operating room for exploratory laparotomy and removal of 34 cocaine packets. Ongoing treatment for cocaine overdose was also utilized. The patient recovered without complications. Discussion This case provides insight and awareness for proper diagnosis and management of body packers by physicians and surgeons alike. Conclusion We present a case report of acute cocaine intoxication in a young man who ingested 34 packets of cocaine for means of drug trafficking. Medical approaches are available for cases in which patients remain asymptomatic, but surgical intervention is necessary for those with signs and symptoms of bowel obstruction or drug overdose.

Internal concealment and transportation of illegal substances by body packing is a major business with very high profits, attracting criminals all over the world. As body packers are rarely arrested, it is difficult to quantify their proportion in the general population and, consequently, identify the countries involved in this kind of drug traffic; as a consequence, the percentage of undetected cases is undoubtedly high. The aim of this study is to provide useful information concerning the country of origin of body packers travelling to Italy through the analysis of the United Nations Office on Drugs and Crime Individual Drug Seizures Report database in the period 2010–2015. Results of our study highlighted a total of 85 cases, producing a total of 52.4 kg of drugs transported through body packing towards Italy. Data obtained from our analysis could represent an useful starting point to: (a) enhance police controls on people coming from targeted countries and improve collaborations between Italian Police Forces and those of other countries; (b) understand the reason why some cities/airports are so frequently used in drug trafficking through body packing and, as a consequence, enhance police controls in these places; and (c) train airport security staffs in international airports recognized as important departure points for body packers travelling to Italy.

Introducción: El transporte de sustancias ilícitas en cavidades corporales, es un problema de salud pública al afectar el bienestar biopsicosocial del sujeto y de la población en general. Es un tema de interés poco estudiado y documentado. Objetivo: Describir el estado del arte referente al transporte de sustancias en las cavidades del cuerpo. Método: Se realizó un estado del arte, definido como una investigación documental cuyo objetivo esencial es mostrar construcciones frente a un tema específico, en este caso, relacionado con las sustancias psicoactivas, consumo, transporte y el manejo para personas que transportan sustancias psicoactivas en los diferentes niveles de atención; basado en la propuesta de Consuelo Hoyos, que comprende cinco fases: preparatoria, descriptiva, interpretativa por núcleo temático, construcción teórica, extensión y publicación. Resultados: A partir de las bases de datos y ecuaciones de búsqueda se encontraron un total de 53 artículos, los cuales se filtraron por unidades de análisis: Antecedentes de los Body Packers, definición de body-packers, diferencia body-packers y body stuffers, características y cantidad de paquetes transportados, drogas transportadas, modos de transporte, complicaciones clínicas, sintomatología complicaciones mecánicas y tóxicas, diagnóstico, tratamiento quirúrgico, farmacológico, monitorización durante el tratamiento y actitudes éticas y terapéuticas del personal de salud; consolidando así un total de 34 artículos de las unidades de análisis finales, el cual aportan al objetivo de la revisión y cumple con los criterios de selección. Conclusiones: La información encontrada se basa en estudios de caso que no evidencian el rol de enfermería en la atención a éste tipo de pacientes; asi mismo la literatura tampoco demuestra las diferentes estrategias establecidas por parte de la salud pública, para la prevención del transporte de sustancia ilícitas en cavidades corporales, además de la rehabilitación y reintegración social de aquellos que por falta de educación, trabajo y recursos optan como último medio de supervivencia ser bodypackers. Introduction: The transport of illicit substances in the body cavities is a public health problem for the benefit of the biopsychosocial wellbeing of the subject and the population in general. It is a topic of interest little studied and documented. Objective: Describe the state of the art regarding the transport of substances in the body cavities. Method: A state of the art was made, defined as a documentary research whose essential objective is to show constructions in front of a specific topic, in this case, related to psychoactive substances, consumption, transportation and handling for people who transport psychoactive substances at different levels of attention; based on the proposal of Consuelo Hoyos, which includes five phases: preparatory, descriptive, interpretative by thematic core, theoretical construction, extension and publication. Results: From the databases and search equations, a total of 53 articles were found, which were filtered by analysis units: Background of the Body Packers, definition of bodypackers, body-packers and body stuffers, characteristics and number of packages transported, drugs transported, modes of transport, clinical complications, symptomatology, mechanical and toxic complications, diagnosis, surgical treatment, pharmacological, monitoring during treatment and ethical and therapeutic attitudes of health personnel; thus consolidating a total of 34 articles of the final analysis units, which contribute to the objective of the review and meet the selection criteria. Conclusions: The information found is based on case studies that do not show the role of nursing in the care of this type of patients; Likewise, the literature does not demonstrate the different strategies established by public health, for the prevention of the transport of illicit substances in body cavities, in addition to the rehabilitation and social reintegration of those who, due to lack of education, work and resources, choose as the last means of survival be bodypackers. Pregrado Enfermero(a)

Background The constant need for rapid financial gain drives the international illegal drug industry, which encourages healthy individuals to smuggle drugs through internal concealment. The aim of this study was to evaluate our practice of the management of body packers using a hospital-based protocol in order to validate it. Methods Electronic hospital data were retrospectively reviewed between 2000 and 2013 of all patients that were admitted to Hillingdon Hospital with a history of internal drug concealment. Demographic as well as clinical data including investigations and management were collected. Results One hundred and twenty patients were admitted over the study period to our surgical unit. This included 86 male and 34 female patients with a mean age of 38 (range 19–64) years. Three per cent (n = 4) underwent surgery for either cocaine toxicity or obstruction. The rest of the patients were managed conservatively with bowel cleansing preparations to encourage the natural passage of drug packages. Conclusion Conservative treatment is safe and effective for drug body packers. We therefore recommend conservative management to be the mainstay for body packers with surgery only being indicated on clinical grounds.

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.

This study investigated the sonographic properties of drug packets containing narcotic drugs and the diagnostic role of ultrasonography in detecting body packing in comparison with CT. Forty-five suspects admitted to our hospital for diagnosis and management were routinely evaluated by non-contrast CT for the presence of drug packets. A single radiologist blind to CT data independently performed the abdominal ultrasonographic scans. Thirty-five of 45 suspects were carrying packets. In positive cases, two types of packets with different properties were noted. Twenty-eight cases had type 1 packets (solid form drug) and 7 had type 2 packets (liquid form cocaine). The sensitivity, specificity, positive, and negative predictive values of ultrasonography for detecting drug packets were 91%, 70%, 91%, and 70%, respectively. Ultrasonography accurately determined the presence or absence of packs in 39 of 45 suspects. Ultrasonography was found to have a high sensitivity but a low specificity in suspected cases. A negative ultrasonography cannot rule out the diagnosis of body packing. However, it may be preferred as the initial imaging method or for follow-up of suspected cases as a radiation-free, easy-to-use, and inexpensive technique.

Foreign body ingestion and impaction in the esophagus can happen at any age, although occurring more frequent in children ( 50 years). This problem can happen in both sexes with equal frequency. The risk factors in favor of the esophagus foreign body impaction include impaired vision, poor dentations, psychotic patients, body packers, prisoners, and patients with previous esophageal abrasion. The aim of this article is to study the etiology, clinical presentation, surgical treatment, and complications of foreign body ingestion at the same time as presenting a rare remarkable case.

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.

Le trafic de narcotique implique fréquemment un transport intra-abdominal d’une large quantité de drogue, habituellement de la cocaïne ou de l’héroïne (body packing), ou, lorsque le trafiquant encoure un risque d’arrestation, l’ingestion orale d’une quantité moindre de drogue qui est alors destinée à la vente immédiate (body stuffing). Cette étude a pour but la description des caractéristiques, des complications et du suivi médical d’une cohorte de 132 body packers (n=36), body stuffers (n=83) et cas mixtes (n=13) référés par les autorités à notre service d’urgence sur une période de 12 ans. L’analyse de ces 132 patients n’a pas révélé de rupture ou de fuite intra- abdominale ni d’intoxication aigue. Une intervention chirurgicale a néanmoins été administrée à 3 patients, en raison d’une stase des paquets dans l’estomac. La durée moyenne d’hospitalisation était augmentée lorsque les paquets étaient localisés dans l’estomac en comparaison avec les paquets localisés plus bas dans le tractus digestif (61.9 vs 43.8 heures respectivement), mais sans signification statistique (p=0.13). La longueur du séjour n’était pas corrélée avec la présence de symptômes (aspécifiques) ou du nombre total de paquets ingéré. En conclusion, l’étude de cette cohorte de 132 body-packers et body-stuffers nous a permis d’affirmer que la prise en charge de ces patients est rarement associée à des complications sévères et que la durée de l’hospitalisation est longue, en moyenne 2 jours, avant l’expulsion complète des paquets de drogue. -- Trafficking and sale of narcotics frequently involves the in- tra-abdominal transport of large quantities of drugs, usual- ly 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 stuff- ing”). This study aimed to describe the characteristics, compli- cations 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 emer- gency department over the course of 12 years. Analysis of these 132 cases did not reveal any intra-ab- dominal 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, re- spectively), but this was not statistically significant (p = 0.13). Length of stay was not associated with the pres- ence 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 man- agement of these patients is rarely associated with seri- ous complications, and that their length of stay is generally long, averaging 2 days before complete elimination of the drug packages.

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.

The concealment of packets of illegal substances within body cavities is a common technique for drug smuggling worldwide. The goal of our study was to analyze the results of conservative treatment of “body packers”, indications for surgical intervention, and postoperative morbidity. This is a retrospective study of patients admitted to our hospital and diagnosed as body packers. The diagnostic protocol included an abdominal X-ray and urinalysis for toxic substances. Only patients with gastrointestinal symptoms, signs of intoxication, or a positive urinalysis were admitted for observation. Conservative management included bowel rest and serial abdominal radiographs to confirm the passage per rectum of all foreign bodies. Asymptomatic patients were given laxatives in the emergency department (ED) to promote bowel movements and were not admitted to the hospital. A total of 763 body packers were admitted to the hospital, all of whom were initially treated conservatively. Of these patients, 47 (6 %) developed complications: 28 with bowel obstruction, three with bowel perforation, and 16 with substance intoxication. In patients developing complications, urinalysis for toxic substances was negative in 19 (40 %). Sixteen (34 %) patients who developed complications were successfully managed nonoperatively. Three (6 %) other patients died before surgery: two deaths resulted from acute toxicity (one of them with an acute onset and a negative urinalysis) and the third patient died of bowel perforation. Laparotomy was required in 28 (3.5 %) body packers admitted for observation. Enterotomy and/or gastrotomy to remove the packets were the most frequently performed procedures. Postoperative morbidity occurred in 57 % of patients, with wound infection being the most frequent complication. 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.

BACKGROUND: Body packing is the transport of internally concealed narcotic substances. These may take the form of pellets or sachets, ingested or inserted per anus or per vagina. In France, abdominopelvic scanning without contrast-medium injection is used to check the complete evacuation of ingested narcotics. This sometimes leads to the discovery of incident pathologies, also known as "incidentalomas." OBJECTIVE: Our study described incidentaloma detected by abdominopelvic computed tomography (CT) scanning in body packers. This monocentric prospective study concerned 100 CT scan images from body packers managed in our secure medical unit between September 2009 and April 2010. RESULTS: Thirty-one incidentalomas were discovered on 18 abdominopelvic CT scans, including 2 women. Ten CT scan examinations revealed 1 suspect image, 5 scans included 5 suspect images, 2 scans included 3 suspect images, and 1 scan included 5 suspects images. Once the complete evacuation of all foreign bodies is confirmed, and in the absence of any surgical or medical emergency, incidentaloma management is entrusted to the prison doctors.

To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT). Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination. Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4–58.1) and 100.0 % (95 % CI: 97.0–100.0) for reader 1 and 35.7 % (95 % CI: 12.8–64.9) and 97.6 % (95 % CI: 93.1–99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance. Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers. • Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets. • Ten per cent of body packers had residual packets despite two packet-free stools. • Seventy per cent of these residual packets were missed on AXR. • No patient or packet characteristics predicted residual packets or AXR false negativity. • CT is necessary to ensure safe medical discharge of body packers.

Body packing, pushing and stuffing are methods by which individuals conceal illicit drugs for the purposes of transporting them across borders or evading police discovery. Body packers swallow drugs in rubber or latex packets for trafficking; body pushers insert drug packets into their rectum or vagina, and body stuffers swallow wrapped or unwrapped drugs to dispose of the evidence when fearing apprehension by the authorities. Individuals who swallow or insert illegal substances can present to the ED in a number of ways. They might self-present with acute symptoms of drug toxicity and either withhold or disclose a history of body packing, pushing or stuffing. Police might have witnessed the individual ingesting an unknown substance in the course of an arrest, or the individual might have been detained by federal police at border control sites under suspicion of drug trafficking, before being taken to an ED for investigation. These patients represent a challenging cohort of individuals for ED staff, with each scenario raising complex ethical and medicolegal questions. The article in this issue by Mitra et al. highlights some of the difficulties faced by ED staff in managing cases that involve body packing. The article explores the issues of confidentiality and privacy in determining whether or not to report a suspected case of body packing to the police, and presents an argument for national guidelines surrounding mandatory reporting for medical practitioners in cases where a patient has used, or possesses, illicit drugs. There are currently few circumstances in which the ethical and legal responsibilities of medical practitioners are completely clear-cut in the provision of medical care. In most Australian jurisdictions, mandatory reporting is only stipulated for notifiable infectious diseases, impaired medical colleagues, and cases of suspected child abuse. Yet, on a day-to-day basis, medical practitioners are called on to make significant decisions in many other common scenarios where their ethical and legal responsibilities are ill-defined. The decisions that are made at the time, with little opportunity for reflection or consultation, might unwittingly lead to legal ramifications for both the practitioner and the patient. Despite this, medical practitioners receive little training in the field of law as it pertains to medical practice. Legislation varies between States, and there is often ambiguity surrounding the interpretation and application of specific provisions. Navigating through privacy laws and legislation covering health and criminal issues can be a daunting and indecipherable process. The question of whether to report a patient who presents with concealed illicit substances is but one aspect of a much wider debate regarding duty of care, and reporting to police in cases of body packing, pushing or stuffing. Related issues include the appropriateness of acting on police requests for medical investigations, the retrieval of the drugs for evidence, and the factors surrounding patient safety and discharge planning for persons in custody.

Introduction: We present a case report of a healthy man who ingested a large number of well-manufactured cocaine packages to smuggle them across international borders. Case Presentation: A 36-year-old man ingested cocaine packages worth approximately US $900,000 to transport it from Dubai to Madrid. He was arrested by police at Istanbul Ataturk Airport for suspected body packing of drugs. On arrival to the emergency department of our tertiary-care university hospital in Istanbul, Turkey, he confessed that he had attempted to smuggle 76 packages of cocaine in his gastrointestinal tract. The patient complained of nausea, but did not have abdominal pain. The physical examination was unremarkable. Radiological screening showed many small packages in the abdomen. There were no signs of intestinal obstruction. In this case, repeat computed tomography of the abdomen confirmed complete evacuation. The patient was discharged into police custody six hours later, after passing the number of packets that he had reported to have swallowed. Conclusions: Abdominal radiography and computed tomography are useful tools for in the evaluation of suspected body packers. Improved packaging material used by smugglers and a more conservative treatment approach have reduced the mortality and morbidity.