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Body packing refers to the intracorporeal concealment of illicit drugs. Here we report the case of a 55-year-old body packer who presented with palpitations, visual hallucinations, and a sense of impending death. Abdominal radiography demonstrated five ovoid foreign bodies overlying the rectum. At subsequent gastrotomy and cecotomy, thirty-eight cocaine-containing packets were retrieved from the stomach and ascending colon as well as from the rectum. As the contraband market evolves new techniques to evade detection, evaluation of the burden of body packer ingestion has become increasingly challenging. As demonstrated in this case, plain radiography can grossly underestimate the burden of ingestion. [ABSTRACT FROM AUTHOR]

In this study we describe the smuggling activities involving drugs and cigarettes within the Italian multimodal logistic system in the period between 2004 and 2014. Data concerning the smuggling flows intercepted by Italian authorities are used to carry out detailed studies about the evolution of the trafficking of illicit substances. Several dimensions of these episodes, including geographical analyses, are assessed using quantitative methods to investigate how the international trafficking of such categories has evolved over the last decade. Numerical data shows how the illicit substances and the methods to smuggle them have evolved over time in the Italian logistic network. Detailed data about the geographical areas of origin and the destination of these flows are also provided. These results can be used to implement and develop more robust and effective methods to contrast illegal substances trafficking and/or to evaluate the effectiveness of the measures to curb smuggling activities that are adopted by Italian custom offices and institutions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Radiologists and other clinicians are facing an increasing number of illegal drug-related medical conditions. We aimed to draw attention to this growing global problem and to highlight some of the important points related to diagnosis and follow-up of body packing. We compare the diagnostic performance of unenhanced multidetector CT (MDCT) and abdomen X-ray for the detection of drug-filled packets. Materials and methods: Sixty-seven suspects, who underwent both CT and X-ray examinations, have been included in the study. All MDCT and X-ray images were independently and retrospectively reviewed by two observers with different degrees of experience in abdomen imaging. Fifty-two of them were identified as body packers finally. Interobserver agreement, sensitivity, specificity, positive and negative predictive value were calculated. Results: Two types of packets with different characteristics were identified in all body packers. Type 1 packets (solid-state drug) were found in 41 patients and type 2 packets (liquid cocaine) in 11 patients. All statistical analyses concern the detection of any packets. That is, the whole evaluation has been performed per patient. Sensitivity/specificity values of type 1 and type 2 packets for MDCT were 100–98%/100–100% and 100–100%/100–100%, respectively. Besides, sensitivity/specificity values of type 1 and type 2 packets for X-ray were 93–90%/100–91% and 64–45%/73–71%, respectively. In addition, interobserver agreements for detection of any packets were excellent (κ =0.96) and good (κ =0.75) for interpretation of MDCT and X-ray, respectively. Conclusion: Unenhanced MDCT is a fast, accurate and easily used diagnostic tool with high sensitivity and specificity for the exact diagnosis of body packing. [Copyright &y& Elsevier]

Abstract: Objective: Drug smuggling in the gastrointestinal tract has soared within the last 20 years. Though illegal substances in the gastrointestinal tract can be visualized with ultrasound, MRI and CT, the abdominal radiograph has by far remained the most frequently used way of detecting smuggled drugs. The purpose of the study was to evaluate the inter-radiologist interpretation error and the reliability of the abdominal radiograph in detecting smuggled drugs. Materials and methods: A total of 279 abdominal radiographs of suspected smugglers were classified by three radiologists as clearly positive or negative for drug smuggling. All available information about the cases was collected from the customs officers and police. Results: Out of these cases 203 (73%) were interpreted as negative and 35 (13%) as positive by all three radiologists. In 86% of the cases there was, therefore, an inter-radiological agreement in interpreting the images. In 41 (14%) cases, however, there was an inter-radiologist disagreement. Kappa-value for inter-observer variability was 0.70. Conclusions: In up to a seventh of the abdominal radiographs the interpretation can be challenging even for an experienced radiologist. False positive interpretation can lead to innocent passengers being detained in vain. As negatively interpreted images usually result in releasing of the suspect, there is no way of knowing how many false negative occur. This makes the abdominal radiograph a suboptimal examination, and low dose CT should be considered as the screening modality for gastrointestinal drug smugglers. [Copyright &y& Elsevier]

Abstract: Objective: To assess the possible extent of dose reduction for low-dose computed tomography (CT) in the detection of body-packing (ingested drug packets) as an alternative to plain radiographs in an animal model. Materials and methods: Twelve packets containing cocaine (purity >80%) were introduced into the intestine of an experimental animal (crossbred pig), which was then repeatedly examined by abdominal CT with stepwise dose reduction (tube voltage, 80kV; tube current, 10–350mA). Three blinded readers independently evaluated the CT datasets starting with the lowest tube current and noted the numbers of packets detected at the different tube currents used. In addition, 1 experienced reader determined the number of packets detectable on plain abdominal radiographs and ultrasound. Results: The threshold for correct identification of all 12 drug packets was 100mA for reader 1 and 125mA for readers 2 and 3. Above these thresholds all 3 readers consistently identified all 12 packets. The effective dose of a low-dose CT scan with 125mA (including scout view) was 1.0mSv, which was below that of 2 conventional abdominal radiographs (1.2mSv). The reader interpreting the conventional radiographs identified a total of 9 drug packets and detected 8 packets by abdominal ultrasound. Conclusions: Extensive dose reduction makes low-dose CT a valuable alternative imaging modality for the examination of suspected body-packers and might replace conventional abdominal radiographs as the first-line imaging modality. [Copyright &y& Elsevier]

Abstract: Introduction: “Body packers” either swallow or insert drug filled packets rectally or vaginally in order to smuggle illicit drugs. AXR is used routinely to screen suspects for the presence of intra-intestinal drug packages. AXR diagnosis can be difficult as stool or gas within the intestine may resemble ingested foreign bodies. We identify the frequency and co-existence of several signs; tic-tac sign, rosette sign, double condom sign, dense surrounding material, density and discover a new sign; parallelism, which will aid in increasing the radiological accuracy. Methods: We retrospectively reviewed 285 AXRs performed for suspicion of drug smuggling during the period of March 2006–March 2009 to identify the frequency of these signs. Results: Of the 285 AXRs performed 59 were positive, 221 negative and five were indeterminate. The tic-tac sign was present in 93%, double condom sign in 73%, dense surrounding wrapping material in 36% and parallelism in 27%. Sixty one percentage of drug packages were iso-dense to faeces and 39% hyperdense. Twenty percentage of the positive abdominal radiographs demonstrated one of the radiographic signs, 39% demonstrated two signs, 32% demonstrated three and 7% four. The most common radiographic sign combination was the tic-tac sign with either dense surrounding material or double condom sign. Conclusion: The most commonly encountered radiographic sign is the tic-tac sign, followed by the double condom sign and dense surrounding material. We also discover a new sign, “parallelism” which although uncommon is highly specific. Accuracy is further increased by comparing the density of packages to faeces and looking for the co-existence of multiple signs. [Copyright &y& Elsevier]

The use of terms “body packing” and “body pushing”, both encompassed in the idiomatic expression “body packing”, is still misunderstood by clinicians. “Body packing” is a general term used to indicate the internal transportation of drug packages within the gastrointestinal tract; while “Body pushing” refers to the insertion of drugs in anatomical cavities or body orifices, such as the anus, the vagina, and the ears. With the present paper, we would like to analyze and clarify some issues concerning the confounding definitions of body packing and the main reasons why some drug packages may be undetected at plain abdominal radiography, providing important false negative findings, as in the case commented. [ABSTRACT FROM AUTHOR]