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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.

Introducción. El embalaje y transporte de estupefacientes dentro del organismo, o body packing, es una práctica frecuente en Centroamérica y el Caribe. Además del riesgo de muerte por la exposición a las sustancias tóxicas, existe el riesgo de complicaciones mecánicas con indicación de manejo quirúrgico. El Hospital de Engativá, por su cercanía al aeropuerto de Bogotá, D.C., Colombia, es el centro de referencia para el tratamiento de estos pacientes. Caso clínico. Un hombre de 65 años traído al hospital por un episodio emético con expulsión de cuatro cápsulas para el transporte de estupefacientes. Al examen físico se encontraron masas palpables en el hemiabdomen superior, sin abdomen agudo. La tomografía de abdomen informó un síndrome pilórico secundario a retención gástrica de cuerpos extraños. Fue llevado a laparotomía y gastrotomía logrando la extracción de 97 objetos cilíndricos de látex que contenían sustancias ilícitas. Discusión. En los body packer asintomáticos, la administración de soluciones laxantes es una estrategia terapéutica segura. Los casos reportados de obstrucción gastrointestinal son infrecuentes y se relacionan con la ingesta de un gran número de cápsulas, por lo que es necesario el tratamiento quirúrgico. Conclusión. El síndrome pilórico es una presentación infrecuente en un body packer. Se debe tener un alto índice de sospecha para garantizar un manejo oportuno.

Abstract Background French Guiana is used as a drug trafficking pipeline of cocaine to Europe. The number of arrests for transporting cocaine in corpore has increased exponentially in recent years. Since 2010, Cayenne Hospital's emergency care unit has applied a medical management protocol system for body‐packers. Our objective was to describe the epidemiology of body‐packers and to evaluate medical management. Method A retrospective descriptive study was performed among patients hospitalized in Cayenne Hospital for transporting cocaine in corpore between January 2010 and November 2015. In addition, a qualitative study including interviews of body‐packers imprisoned in Rémire‐Montjoly prison was conducted in April 2016. Result A total of 282 patients were included in the study. The median age was 24 years and the sex ratio M/W was to 4/1. Among them, 3.5% showed signs of severity (9 with pre‐existing condition and 1 with severe form). No surgery or deaths were reported. Ten endoscopies were performed because of the delay in evacuation without complications. Approximately 28% of patients had urinary screening, of which 60.7% were positive. The median length of stay was 1.8 days. Prolonged length of stay was significantly associated with the presence of gastrointestinal symptoms, hypoglycemia, or having swallowed a minimum of 10 pellets. Conclusion This study led to a change in the management of body‐packers in the hospital setting in Guiana. A computed tomography scan at discharge became more prevalent. Endoscopy has emerged as an effective and safe alternative to surgery. Despite the increase in the number of patients treated, it should be noted that there were few complications and no deaths in our cohort.

The human body is often used for illegal drug trafficking around the world. This may be done by concealing the drugs inside the body, so-called “body packing”. This can lead to life-threatening conditions, mainly by leakage of the illegal substances in lethal amounts into the circulation system, which may cause fatal consequences due to acute drug overdose. Most of these cases present as sudden unexpected deaths. However, we present herein a case in which the death of an unidentified victim, which was notified as a case of seawater drowning in a non-suspicious manner, but later proved to be the death of a body packer as a result of drowning due to a morphine overdose. This case highlights the importance of investigating deaths even in unidentified bodies and the different presentations of fatal consequences of a body packer, which previously have not been described in literature.

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.

In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.

INTRODUCTION Drug traffickers are increasingly making use of the human body for illegal drug transport. Three ways of intracorporeal drug transport are practiced, namely “body packing”, “body stuffing” and “body pushing.” Since police and border guards cannot accurately detect intracorporeal drug transport, authorities require medical professionals for examination and radiological imaging. The aim of this retrospective study was to assess outcomes in all presentations of suspected intracorporeal drug transport referred to the Emergency Department (ED) of the University Hospital of Basel. METHODS We screened the electronic health records (EHRs) of all presentations to the ED between 1 January 2008 and 31 December 2017 for combinations of keywords “body”, “pack”, “stuff” and “push” in the diagnosis and history of presenting complaints. All presentations with suspicion of intracorporeal drug transport were included. Patient characteristics, imaging modality and the results of imaging were assessed. Outcomes were length of stay, hospitalisation, admission to the intensive care unit, surgical intervention and mortality. The main outcome was the rate of surgical interventions during follow-up in hospital and in prison. RESULTS We included 363 presentations in 347 patients. The median age was 35 years and 46 (12.7%) were female. Positive results of imaging were found in 81 of 353 (22.9%) presentations assessed by imaging. In four presentations (1.1%), the result of imaging was indeterminate; in 10 presentations, no imaging was obtained owing to lack of consent or pregnancy. We observed 36 instances of body packing, 10 of body stuffing and 15 of body pushing, and 20 mixed or indeterminate presentations. The number of suspected presentations has risen over the last decade, and the relative number of positive results has almost remained stable over the last six years. No severe or life-threatening complications, interventions, or deaths were observed. Among the presentations with positive imaging results, ten (12.3%) were observed in hospital, as compared with four (1.5%) of those with negative results. CONCLUSIONS Presentations have increased over the last decade while no severe complications or deaths were observed. The consistently low complication rate supports outpatient observation. Considering the ongoing discussion in media and politics, we suggest validation of medical, legal, and ethical guidelines.

One method of drug smuggling is body packing or body stuffing, placement of narcotics (opium, heroin, hashish, …) inside intestinal tract for transfer from city to city or country to country. Estimating of the methods for transferring, content of packets, packaging, cause of death and results of diagnostic and therapeutic methods can effectively decrease the number of body packer and law execution. This study is case series by randomized sampling. Several parameters such as sex, age, marital status, addiction, job, level of education, type of opioids and their weight and number of packets, result of abdominal X-ray, surgery needs, were collected from April 1999 to December 2000. Through this period of time, 32 male smuggler who had swallowed drug packets were detained. The average age was 41 years (max=62, min=20). The minimum weight of the opium carried by this smugglers was below 20 gram and maximum weight was 1000 grams (median=360 grams). The minimum number of packets were one packet and maximum number of packets were 54 (median=10 packets). In 84 percent of body smugglers the content of packets was opium, 13 percent was heroin and 3 percent was hashish. From the cases, 81 percent of smugglers were addicts themselves. Death occurred in 7 cases from which 3 were after surgery.