https://wikem.org/w/index.php?action=history&feed=atom&title=Body_packing%2Fen 2026-04-17T07:25:32Z Revision history for this page on the wiki MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Body_packing/en&diff=380161&oldid=prev 2026-01-06T21:26:37Z

<p>Updating to match new version of source page</p> <p><b>New page</b></p><div>&lt;languages/&gt;<br /> <br /> ==Background==<br /> <br /> [[File:Blausen 0817 SmallIntestine Anatomy.png|thumb|Small bowel anatomy with surrounding structures.]]<br /> [[File:Bodypacks.jpg|thumb|Seized cocaine containers (i.e. bodypacks).]]<br /> [[File:PMC3522363 iranjradiol-08-205-g001.png|thumb|Illicit drugs evacuated from a body packer. They are packed tightly and wrapped into aluminum foil.]]<br /> *Body packers, also called &quot;mules&quot;, swallow or insert drug filled packets into body cavity, usually to smuggle them across borders<br /> *Packets usually made of several layers of latex and outer wax coating<br /> *Each packet contains about 10g of drug and body packers ingest between 50 to 100 drug containers at a time&lt;ref&gt;Booker RJ. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J. 2009;26(5):316-20.&lt;/ref&gt;<br /> *Sometimes packets are inserted rectally or vaginally<br /> *Distinct from [[Special:MyLanguage/Body stuffing|Body stuffing]] (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)<br /> <br /> {{FB types}}<br /> <br /> <br /> ==Clinical Features==<br /> <br /> *Situations in which body packers present to the ED:<br /> **Asymptomatic but in custody <br /> **Signs of [[Special:MyLanguage/toxidromes|toxidromes]] from a ruptured packet<br /> **Signs of [[Special:MyLanguage/bowel obstruction|bowel obstruction]] or perforation<br /> *History and physical<br /> **Type of drug<br /> **Type of packet wrapping (more likely to rupture or leak if home made)<br /> **Number of packets ingested<br /> **GI symptoms ([[Special:MyLanguage/abdominal pain|pain]], distention, obstipation)<br /> **Other drug use <br /> <br /> <br /> ==Differential Diagnosis==<br /> <br /> {{Drugs of abuse types}}<br /> <br /> <br /> ==Evaluation==<br /> <br /> [[File:PMC3522363 iranjradiol-08-205-g002.png|thumb|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]<br /> [[File:Bolletjes.jpg|thumb|Abdominal X-ray showing swallowed packages of cocaine.]]<br /> [[File:PMC3522363 iranjradiol-08-205-g005.png|thumb|(A) plain x-ray reveals several uniform radiopaque packets; B-C, Abdominal CT scan without oral contrast shows numerous randomly distributed packets within the small bowel and colon. Their density is 150-170HU which is compatible with the density of opium.]]<br /> *Imaging: KUB, CT abdomen pelvis<br /> *[[Special:MyLanguage/Urine drug screen|Urine drug screen]]: may be misleading<br /> <br /> <br /> ==Management==<br /> <br /> *Asymptomatic patients<br /> **Expectant management, no surgery, close monitoring in ICU until passage of all packets<br /> **[[Special:MyLanguage/Whole bowel irrigation|Whole bowel irrigation]] with polyethylene glycol via NGT at 2L per hour<br /> **[[Special:MyLanguage/Activated charcoal|Activated charcoal]] more useful in body stuffers<br /> *[[Special:MyLanguage/Opioid toxicity|Opioid toxicity]]<br /> **[[Special:MyLanguage/Naloxone|Naloxone]]: may require very high doses <br /> ***2 to 5mg IV initially, repeat 2mg q5min until responsive<br /> ***then total amount required for response should be given every hour as continuous drip<br /> *[[Special:MyLanguage/Sympathomimetic toxicity|Sympathomimetic toxicity]]<br /> **Immediate OR for surgical decontamination<br /> **No place for conservative management<br /> **Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR<br /> ***[[Special:MyLanguage/Hyperthermia|Hyperthermia]]<br /> ****Active external cooling<br /> ****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]] ([[Special:MyLanguage/midazolam|midazolam]] 1 to 2mg IV or [[Special:MyLanguage/diazepam|diazepam]] 5 to 10 mg IV, rapid escalation in dosing)<br /> ***[[Special:MyLanguage/Hypertension|Hypertension]]<br /> ****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]], [[Special:MyLanguage/phentolamine|phentolamine]], [[Special:MyLanguage/nitroprusside|nitroprusside]], [[Special:MyLanguage/nitroglycerin|nitroglycerin]],, or [[Special:MyLanguage/nicardipine|nicardipine]]<br /> ***[[Special:MyLanguage/Seizures|Seizures]]<br /> ****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]], followed by [[Special:MyLanguage/propofol|propofol]] if needed<br /> ***[[Special:MyLanguage/Ventricular dysrhythmias|Ventricular dysrhythmias]]<br /> ****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]], followed by hypertonic [[Special:MyLanguage/sodium bicarbonate|sodium bicarbonate]] if wide QRS<br /> *[[Special:MyLanguage/bowel obstruction|Obstruction]] or perforation<br /> **OR for immediate ex-lap, then advanced imaging study to document a clear GI tract<br /> **Endoscopic removal highly controversial, risk of packet perforation<br /> <br /> <br /> ==Disposition==<br /> <br /> *Admit all to ICU, regardless of symptoms<br /> *Complete GI decontamination by contrast CT should be documented prior to discharge<br /> **History is unreliable<br /> **Passage of 2 or 3 packet free bowel movements is not sufficient&lt;ref&gt;Rousset P. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study. Eur Radiol. 2013;23(8):2146-55.&lt;/ref&gt;<br /> <br /> <br /> ==See Also==<br /> <br /> *[[Special:MyLanguage/Body stuffing|Body stuffing]]<br /> *[[Special:MyLanguage/Drugs of abuse|Drugs of abuse]]<br /> *[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]]<br /> *[[Special:MyLanguage/Rectal foreign body|Rectal foreign body]]<br /> <br /> <br /> ==External Links==<br /> <br /> <br /> ==References==<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category:GI]]<br /> [[Category:Toxicology]]</div>

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