Body packing

Background

Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.
  • Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders
  • Packets usually made of several layers of latex and outer wax coating
  • Each packet contains about 10g of drug and body packers ingest between 50 to 100 drug containers at a time[1]
  • Sometimes packets are inserted rectally or vaginally
  • Distinct from Body stuffing (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)

Clinical Features

  • Situations in which body packers present to the ED:
  • History and physical
    • Type of drug
    • Type of packet wrapping (more likely to rupture or leak if home made)
    • Number of packets ingested
    • GI symptoms (pain, distention, obstipation)
    • Other drug use

Differential Diagnosis

Evaluation

Management

Disposition

  • Admit all to ICU, regardless of symptoms
  • Complete GI decontamination by contrast CT should be documented prior to discharge
    • History is unreliable
    • Passage of 2 or 3 packet free bowel movements is not sufficient[2]

See Also

External Links

References

  1. 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.
  2. 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.