body packing

Body packing refers to the internal concealment of drugs within the gastrointestinal tract or other orifices. People who do this may be called body packers, (drug) mules, stuffers, couriers or swallowers. Drugs may be concealed within condoms, foil, latex or cellophane.

Epidemiology

There is a tendency for most presenting patients to be young, with an average age ~30 years, and 80% are male .

Clinical presentation

Patients may be brought in by law enforcement authorities for screening of suspected internal concealment of drugs.

Most patients are asymptomatic but may present with symptoms of complications (e.g. perforation, obstruction) or drug intoxication (which may be intentional or unintentional) .

Urinalysis may also be positive for illicit drugs.

Radiographic features

Both plain film and US can be used for assessment but non-contrast CT is the most effective at detection .

Plain radiograph

• may reveal smooth, well-circumscribed foreign bodies measuring approximately 2-3 cm (although may be variable in size and shape)
  • with or without surrounding air-rim or halo from air within the packets (the 'double-condom sign')
  • 'rosette-sign' of air trapped within the tied-off end
• may detect up to ~75% (range 60-88%) of packages
• use of foil-wrap packages (instead of condoms) may increase false-positive results

Ultrasound

US can be useful in younger patients, especially in pregnant women. Appearances vary depending on the exact method of concealment, but are morphologically similar to those on CT.

In a study of 50 patients, Meijar and Bots demonstrated US was able to correctly identify the presence or absence of packets in 47 cases with a positive predictive value of 97.5% .

However, radiographs and CT have the advantage of also being able to evaluate for associated complications of gastrointestinal obstruction or perforation and are less limited by visceral gas.

CT

• may reveal smooth, well-circumscribed foreign bodies measuring approximately 2-3 cm (although may be variable in size and shape)
• can accurately determine size, number, and location, and assess for complications
• reported Hounsfield unit (HU) density of various illicit drugs :
  • opium: 165-200 HU
  • cocaine: ~220 HU
  • heroin: ~520 HU
• non-contrast CT has a diagnostic accuracy of 97-100%

Treatment and prognosis

Most asymptomatic cases (95%) are treated conservatively (e.g. laxatives). Symptomatic or complex patients (5%) may require laparotomy and surgical intervention for complications .

See also

• radiological manifestations of recreational drug use

Siehe auch:

• Fremdkörper in Anus und Rektum