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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.

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.

Introduction: This study aims to describe the clinical and forensic features of the cocaine body packer in Senegal. Materials and Methods: This research work is a retrospective and descriptive study. It was conducted based on 19 suspect cases attended for medical care at the Hospital of tambacounda. Results: Suspects were exclusively male subjects, aged 24 to 33 years and Nigerian citizens. All of them were asymptomatic. Pelvic touch was positive in 42.1% of cases. Abdominal radiography pointed out that all the suspects presented with damage (100%). The average number of drug pellets carried per person was 43+/- 20 units. Conclusion: Body drug packing is a reality in Senegal. Narcotic drug policies should invest in capacity building by financing effective diagnostic tools. Keywords: Body packing, Drug smuggling, clinical forensic medicine, Cocaine, Senegal

Foreign body ingestion comprises a true foreign body (ie, non-food) ingestion and food bolus impaction. Foreign body ingestion is not uncommon and accounts for roughly 4% of urgent endoscopies undertaken.1 2 True foreign body ingestion is mostly encountered in paediatric populations with 75% of cases occurring in less than 5-year-old children.1 Coins, buttons, plastic items, batteries and bones are common culprits.3 Food bolus impaction on the other hand is mostly seen in adults, usually accidental (95% of cases). Steakhouse syndrome, animal bones, toothpicks and fish bones are the most frequent.2 True foreign body ingestion (coins and dentures) is rare in adults. Intentional true foreign body ingestion can be seen in patients with psychiatric illness, prisoners (secondary gain) and drug dealers (‘body packing’). Underlying oesophageal conditions including eosinophilic oesophagitis (10% in adults, up to 50% in children), motility disorder, stenosis and diverticula are frequent.2 4 Most ingested foreign bodies will pass spontaneously.5 However, 10%–20% require endoscopic removal, and less than 1% require surgical extraction or treatment of a complication.6 This review focuses on the management of foreign bodies located in the upper gastrointestinal tract, in adults. The quality of evidence of the guidelines is low; however, substantial clinical experience provides strong levels of recommendation.7 8 The management of rectal foreign bodies mostly relies on surgical, transanal extraction and is not detailed herein. Precise history (type of foreign body, time of onset) is essential. Physical examination is also mandatory. Most patients are asymptomatic. Symptoms arise when the foreign body is stuck in the oesophagus or when a complication occurs (obstruction and perforation).9 Emesis, retching, blood-stained saliva, hypersialorrhoea, wheezing and/or respiratory distress in non-communicative patients (children and psychiatric patients) are suggestive of foreign body impaction.7 Oesophageal impaction (food bolus) is often symptomatic: retching, …

Background: Body packing is the concealment of illicit drugs enclosed in containers inside the body by swallowing or insertion into the rectum or vagina, usually for transportation to escape detection by customs agents. This report seeks to explore ways of establishing general definition of body packer in the Moroccan context and assess it’s possible implications on data collection and future research. Materials and Methods: This is a descriptive and analytical retrospective study of two fatal cases related to Cocaine toxicity of body packers. The deceased underwent an autopsy at Medico-legal institute of Ibn Rochd University Hospital (UHC) of Casablanca, Morocco. Cases presentation: In these index cases, 02 male youths of foreign nationality in their twenties died in Casablanca airport. The young men took ill at the airport. Abdominal CT scan subsequently performed at the hospital revealed intra-abdominal capsules in both cases. Autopsy showed 47 whitish capsules in the stomach and colon in the first case and 67 similar capsules in the small intestine in the second case. Rapid toxicology testing in the forensic laboratory confirmed the powder to be cocaine. The cause of death was secondary to acute intoxication by leakage of cocaine substances from their packaging. Conclusion: Prevention and compliance with the legislation governing drug trafficking activities, are of vital interest in reducing the incidence of youth use as vectors of drugs and mortality consequence.

PurposeBody-packing means concealing packets of illicit psychoactive substances in the digestive or genital system. The purpose of this paper is to investigate profiles of body-packers and comorbidities associated with body-packing.Design/methodology/approachA retrospective study (2005–2016) was conducted among all patients hospitalized for suspicion of body-packing in the Geneva hospital prison unit (n=287). Data were extracted from medical records and included demographics, somatic/psychiatric diseases, suicidal ideation and psychological distress.FindingsBody-packers were mostly young men (mean age=33.4). A total of 42.2 percent of the participants had at least one psychiatric or somatic comorbidity reported during incarceration (somatic: 28.2 percent, psychiatric: 18.8 percent). The most frequent somatic diseases were infectious (10.5 percent), cardiovascular (10.1 percent), and endocrinological (4.2 percent) diseases, and more precisely HIV (4.5 percent), hepatitis B (3.5 percent), hepatitis C (1.4 percent), high blood pressure (8.0 percent) and diabetes (4.2 percent). The most frequent psychiatric conditions were substance use disorders (10.5 percent) and mood disorders (8.0 percent). Depressed mood/psychological distress and suicidal ideation were frequently reported during hospitalization (27.2/6.6 percent). Comorbidities were associated with demographics: Females were more likely to have somatic and psychiatric diseases detected during hospitalization in detention and participants from Western, educated, industrialized, rich and democratic countries were more likely to report diseases known before detention.Originality/valueBody-packers bear a heavy burden of disease and psychological distress. This vulnerable subgroup of incarcerated people has been overlooked in previous research and their health needs are not correctly understood. This study was a first step to improve their health care and reintegration.

Body packing is one of the common ways to traffic illicit drugs. Drug mules usually swallow or insert drugs within the gastrointestinal tract or other orifices. Detection of such drug packets has become difficult because of the constantly improving packaging techniques and the sophistication used by traffickers. Suspected obstruction or perforated hollow viscus requires employment of appropriate radiological procedures and techniques for accurate detection and precise diagnosis. A delay diagnosis and inappropriate action may carry disastrous physical consequences for the body packers. It is crucial for radiologists to acquire enough experience to deduce different types of drug packets from their imaging characteristics and to accurately guide emergency physicians and security officials. The packets are not always radiodense, therefore they can be difficult to detect on conventional abdominal radiographs. In this report, the authors illustrate 5 cases with different packaging methods and materials that give rise to radiological challenges. Keywords: Body packer, Illicit drug smuggling, Imaging modalities

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.

Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as “body packers”, “stuffers”, “mules” or “swallowers” and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.

Introduction Different methods are used to confiscate evidence whenever suspected body packers or body stuffers are taken into custody. Among these, controlled defecation and analysis of drug toilets from suspects has proved to be safe given that no invasive or forceful procedures are applied. Materials and methods All records of “drug toilet” evaluations done at the Hamburg Institute of Legal Medicine from January 1st 2018 to April 30th 2021 were descriptively analyzed for the individual’s age, sex, country of origin, and whether the drug toilets contained any drug “balls”, packages or containers. In case of a positive finding, the total number of balls found were recorded. Special cases are presented in detail for illustrative purposes. Results Drug toilets from 72 suspects were examined in the period under review. 98.6% (n = 71) of the suspects were males and relatively young with approximately two-thirds (62.5%, n = 45) aged 34 years or below (range 18–50 years). The majority of suspects originated from African countries (72.2%, n = 52). The typical drug balls or containers were found in 13 (18.1%) of the examined drug toilets. Conclusion Negative drug toilets might indeed indicate that the suspect had not ingested any drug packages at the time of arrest or while in custody. However, multiple excretions, voluntary delay of defecation, use of drugs to delay the excretion process or even individual differences in excretion times are possible, and therefore, a negative drug toilet should not always imply with certainty that the individual in question had not ingested any drugs.

Background: Body packing is the smuggling of drugs and other contents inside the human body and may represent a serious health risk. Despite studies from several countries, the clinical and surgical aspects of this emergency in Brazil have not been well-explored, especially when considering non-narcotic contents. Thus, the main objective of this study was to investigate cases of body packers treated by the surgical emergency service of a tertiary hospital in a central region of Brazil. We sought to highlight this medical emergency by considering both narcotic and non-narcotic contents smuggled by body packers. Methods: This retrospective study analyzed the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil. Ten cases of body packing were observed. Results: Only 50% of the patients carried drugs, while surprisingly, 70% carried non-content, such as cell phones (40%), cell phone chargers (40%), Durepox adhesives (10%), small saws (10%), and pen-drives (10%). All the patients were male, inmates, and young adults, and body packing was carried out by oral ingestion. In 20% of the cases, there were no important clinical manifestations; in 60% of the cases, there were signs and symptoms of gastrointestinal obstruction; and in 30%, there was acute narcotic intoxication. Abdominal radiography was used for diagnosis in 80% of the cases, and endoscopy and tomography were used for the remaining 20%. In 90% of the cases, emergency laparotomy with gastrostomy was required. All the patients successfully recovered. Conclusions: There was a higher prevalence of body packing of non-narcotic content; however, clinical and radiological presentations were similar to those of narcotic content, except for the presentation of acute narcotic intoxication. Emergency surgery was the most utilized intervention for the body packers and proved to be effective for both content types. This study highlights the concerning high prevalence of body packing of cell phones and accessories in addition to drugs; therefore, health professionals, surgeons, and security agents must be aware of the involvement of body packing in the trafficking of non-narcotic contents in Brazil.

Because of availability and low radiation dose level, low dose computed tomography (CT) is now commonly used to identify illicit in corpore drug transportation. This review illustrates the most common CT findings of in corpore drug transportation and describes complications due to in corpore drug transportation, with a special emphasis on low dose CT. Major information such as number of packets, exact location and aspect of packets must be assessed. Radiologist must be aware of the imaging characteristics of "in corpore" illicit drug transportation, and should know situations that may alter drug smugglers management.

Background: Intrabody concealment of illicit substances is a common practice in the trafficking chain. Body packing is a technique used in drug trafficking that consists of deliberately ingesting many drug pellets. Body stuffing consists of precipitously swallowing packets of substances, which are smaller and more fragile than body-packing pellets, for concealment from law-enforcement officers in anticipation of impending search or arrest. Therefore, body stuffing is particularly dangerous due to the rupture risk of the loosely wrapped drug packets, which could lead to substance intoxication or even death. Case presentation: This article reports the case of a young man who was taken by law enforcement authorities to our Emergency Department for investigation of suspected body stuffing. Although the patient denied the facts, the initial reading of the computed tomography (CT) scan confirmed the presence of multiple images compatible with drug pellets, which were mostly in the stomach. The pellet findings were more consistent with body packing than body stuffing as initially suspected by the police. However, upon admission to our secured inpatient ward for clinical surveillance of pellet evacuation, the patient denied again having ingested such pellets, and declared that he only ate ‘fufu’. Fufu is a traditional food of central and western Africa consisting of a starchy preparation compacted by hand into small balls. Fufu balls are usually swallowed without chewing to allow a sensation of stomach fullness throughout the day. Considering the fufu intake history, a careful reassessment of the imaging confirmed the presence of food content. Conclusions: This case study offers an example of suspected intrabody concealment of illicit substances, which turned out to be false positive due to fufu. It illustrates the importance of a history of food intake that could bias the interpretation of CT scan images.

We present a case of a 39-year-old man who was brought in by ambulance to the ED after ingesting 103 packets of cocaine prior to return to the United Kingdom (UK) from Holland. He presented with a persistent sinus tachycardia and mild abdominal pain but no evidence of peritonitis on examination. Contrast-enhanced CT showed widespread distribution of packets from the stomach to the sigmoid colon. He was taken to theater for emergency laparotomy and retrieval of the packets, which was done successfully without the need of any bowel resection. He was then discharged to police custody following a 10-day admission. This is the highest number of cocaine packets reported in the UK literature. This case report discusses the importance of a multidisciplinary approach in safely managing body packers who also present with signs of cocaine toxicity.

LETTER TO THE EDITOR:A 28-year-old prisoner presented with a one-year history of dysphagia and weight loss (BMI 18). Initially, he self-discharged from another trust after CT neck suggested a plastic foreign body encapsulating softer material lodged within a pharyngeal pouch at the level of T2-T3 (Figure 1). Referred as having “?Swallowed drugs”, he denied ingesting any non-food items or recreational drugs although remained unable to provide a cohesive history. Despite recently undergoing investigation for mental health concerns, he reported no other significant past medical history. Sinus bradycardia (33bpm) with a normal QTC incited suspicion of systemic absorption of intra-corporeal illicit drugs. Given the inconsistent history, bradycardia and imaging, the team maintained high suspicion and pre-emptively sought guidance on the ethics of drug testing and preservation of evidence. Unexpectedly, a plastic bottle cap was removed during rigid panendoscopy, which contained digested food substances. Pharyngoscopy revealed a significant oesophageal stricture at 24cm with no cricopharyngeal bar suspicious of chronic inflammatory stricture. 24-Hour ambulatory ECG recording confirmed only sinus bradycardia. He was discharged back to prison once eating and drinking, aiming for recurrent dilatation every two weeks until luminal diameter reached >15mm.Foreign body ingestion remains rare in adults but prevalence is greater in the elderly, drug traffickers, prison inmates and patients with psychiatric conditions[1]. Intentional ingestion of foreign bodies is more common in incarcerated populations due to perceived secondary gain, pica or psychiatric conditions[2]. Malingerers display repetitive, intentional ingestion of multiple items and may be associated with other self-harm behaviours[3]. Objects typically include sharp metals, batteries or plastic-wrapped illegal drugs. The prevalence of drug abuse within prison populations is high, with illicit substances often concealed by body packing[4]. Rupture of packaging with consequent leakage of contents may result in lethal intoxication. Imaging is notoriously difficult to interpret as scybala, fruit stones or grains may imitate packaged drugs.Clinical judgement remains pivotal in formulating diagnoses and optimising medical management. However, balancing rational associations with unconscious bias is ethically challenging. A cautious balance must be struck between implicit bias and clinical suspicion when considering the management of oesophageal foreign bodies. Overall, we propose it is clinically safer to manage such patients under the presumption that any packaging contains illicit substances. However, no patient should have their care compromised due to race, gender, age or background. As prison populations continue to rise, further work needs to be done to tackle implicit bias within a healthcare setting.WORD COUNT: 398 words

Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages. LEARNING POINTS: Body packing is a potentially lethal activity. Body-packers can be asymptomatic, or have signs/symptoms of systemic drug toxicity or gastrointestinal obstruction or perforation. It is essential to recognize this condition so that the correct clinical approach, diagnosis and management can be established.

Background: Body packing is a frequently used method for drug trafficking. Local information about the clinical and radiological features of body packing is lacking. Objectives: To evaluate the radiological features of body packers presenting to a hospital near to the Hong Kong International Airport and to compare the radiological features of solid form versus liquid cocaine. Methods: This was a retrospective cohort study. Medical notes of 269 suspected body packers, presenting to the Accident and Emergency Department of North Lantau Hospital under the detention by the law enforcement personnel from 1st January 2015 to 28th February 2017, were reviewed. The radiological features of body packing were retrospectively evaluated. Results: Sixty-nine cases were confirmed body packers radiographically. Majority of them (81%, 56/69) were cocaine packers. Powder form cocaine (67%, 49/69) was the most popular drug packed, followed by liquid cocaine (15%, 10/69). There was a trend of increasing incidence of liquid cocaine packers. The classical ‘double condom’, ‘tic tac’ and ‘halo’ signs were present in 94%, 72.5% and 42% of cases with radiologically confirmed body packing respectively. The ‘rosette’ sign was only identified in 1 case. Three new radiological signs, the ‘bag of eggs’, ‘lucent triangle’ and ‘black crescent’ sign, were suggested to aid identification of drug packets. The classical ‘tic tac’ sign was absent in all liquid cocaine packing cases (pConclusion: Failure in detecting drug body packing may result in medicolegal consequences. Emergency physicians need to be aware of subtle radiological signs of liquid cocaine packets in the plain abdominal radiography.

Drug trafficking is an international problem. The prevalence of drug trafficking and newer concealing methods has been ever increasing. Body packing is described as using the abdominal or pelvic cavity for concealing illegal drugs. Body pushers smuggle illicit drugs by inserting them into rectum or vagina. These cases are either presented to the emergency departments as Body Packer Syndrome or as asymptomatic cases for observation, detained for alleged possession of contraband substances. We report a unique case of an asymptomatic white female who was detained at Mumbai International Airport under suspicion and brought to hospital for observation. X ray and CT scan examination revealed 7 wrapped packets in gastrointestinal track and 1 large packet in vagina. A case of female body packer using multiple modalities of concealment especially in vagina is rare in India so it is becomes imperative to present this case in the light of body packing and body pushing of contraband substances.

Body packing is defined as the ingestion of drug packets, to conceal them during transportation. We report the case of a 63-year-old cocaine body packer, who died from an aortic dissection. He was arrested in Paris as he disembarked from a flight from Cayenne (French Guinea) and custom officers found cocaine in his suitcase. The patient admitted the ingestion of cocaine packets. He was transferred to the hospital where an initial computerized tomography scan showed hyperdense, uniformly shaped packets located in the colon. On admission, his blood pressure was elevated but he did not exhibit any other signs of adrenergic syndrome. The diagnosis of chronic hypertension unrelated to the cocaine body packing was retained. During hospitalization, 40 h after the ingestion of the cocaine packets, the patient showed acute agitation, sweat and a high blood pressure. Given the context, an emergency thoraco-abdominal-pelvic CT-scan was carried out to rule out a cocaine leakage. None of the packets showed evidence of leakage but the CT-scan assessed an aortic dissection extending to the entire descending aorta. Despite intensive care, the patient passed away on the fifth day. This aortic dissection could have appeared spontaneously in a patient with significant atherosclerosis lesions of the aortic network. Nevertheless, we believe that cocaine impregnation causing high blood pressure might have played a role in the aortic dissection, even without a cocaine leakage from the packets. This case highlights the need to achieve an effective control of the blood pressure in cocaine body packers.

Little is known about methamphetamine body stuffers and correlation of clinical manifestations with imaging studies. Current study was done to determine abdominopelvic computed tomography findings and clinical manifestations in methamphetamine body stuffers. In an IRB-approved routine data base study, demographic characteristics, clinical findings, and CT results of 70 methamphetamine body stuffers were retrieved. According to the clinical manifestations, the patients were categorized into either benign- or severe-outcome group. Also, they were determined to have positive or negative CT results. In the group with positive results, number and place of the baggies were determined, as well. Results of the CT were compared between the two groups. Almost 43% of the patients had positive abdominopelvic CT results. Mean density of the packs was 176.2 ± 152.7 Hounsfield unit. Based on the clinical grounds, 57% of the patients were in the benign- and 33% were in the severe-outcome group. In the benign group, 45% of the patients had positive CTs while in the severe-risk group, this was 40% (p > 0.05). Except variables defined as severe outcome (seizure, intubation, creatinine level, aspartate aminotransferase level, creatine phosphokinase and troponin level), agitation, on-arrival pulse rate, lactate dehydrogenase, bicarbonate, base excess, loss of consciousness and hospitalization period were correlating factors. But in regression analysis, we could not find a significant variable that prognosticate severe outcome. It seems that there is no relationship between the CT findings and clinical manifestations of the methamphetamine body stuffers. Severe outcomes may be observed even in the face of negative CTs.

Background Body stuffers routinely receive conservative treatment, i.e. administration of the laxative polyethylene glycol for the passage of ingested drug baggies and observation. Endoscopic baggie removal may offer a safe alternative that could result in shorter hospitalization. We aimed to compare complications, hospital stay, and final outcome in body stuffers assigned to endoscopy versus conservative treatment. Methods This is an observational prospective study of body stuffers presenting to a clinical toxicology center in Tehran (Iran) in 2016-2019, irrespective of the drug ingested. Eligible patients had baggies in their upper gastrointestinal tract and presented without severe poisoning. Patients received either endoscopy or conservative treatment, and clinical outcomes were compared between the groups. Results A total of 69 patients were enrolled, with a median age of 29 years (range: 18–64), among whom 1 was female (2%). Eighteen and 51 patients were endoscopically and conservatively managed, respectively. Drugs most commonly ingested were heroin in endoscopy patients (8/18 cases; 44%) and methamphetamine in the conservative group (28/51 cases; 55%). Endoscopy patients had a shorter hospital stay (median 1.5 vs. 2 days, p = 0.018). In the conservative group, one patient died, and the rate of complications was significantly higher, with more patients experiencing side effects (OR= 1.4, 95% CI = 1.2, 1.7) and requiring intubation (OR = 1.3, 95% CI = 1.1, 1.5). Conclusion Endoscopic retrieval was associated with fewer complications and shorter hospitalization. Endoscopy may be a safe treatment for body stuffers without severe toxicity on presentation.

Background: The incidence of smuggling and illegal transport of substances by internal concealment, also known as body packing, is increasing. The clinical approach to body packers has changed significantly over the past two decades. In addition, the mortality of body packers is an important issue in patient management. The purpose of the current study is to determine the statistics and mortality related to body packing. Methods: In this cross-sectional study, all body packer patients who referred to Loghman Hakim hospital were evaluated from 2010 to 2017. Demographic characteristics, findings of clinical imaging, treatment, and outcome of the patients were recorded. The data were analyzed using SPSS version 21. Results: A total of 303 patients were enrolled in the study after the diagnosis of body packing by abdominal CT scanning without contrast. Conservative treatment including whole bowel irrigation (WBI) accompanied by close monitoring was done for 78% (n = 236) of patients; moreover, 26 patients (8.5%) underwent surgery after WBI, and 41 patients (13.5%) underwent surgery without bowel irrigation. Mortality was observed in eight patients (2.7%) five of whom (62.5%) died before surgery and had the clinical manifestation of crystal (methamphetamine) and cannabis toxicity. Furthermore, three patients (37.5%) died due to the complications of surgery such as gastrointestinal leakage of an abdominal abscess. Conclusion: Conservative treatment seems to be better for the management of body packers. In addition, it is necessary to monitor patients for possible signs and symptoms of intoxication and gastrointestinal obstruction.

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.

Background and Aims Foreign body ingestions (FoBIs) are a common cause for medical attention. However, trends and patterns of adult FoBIs as well as associations with clinical comorbidities and behavioral attributes have not been elucidated beyond single institutional experiences. Methods We utilized survey data from the National Electronic Injury Surveillance System to examine fundamental characteristics of adult FoBIs involving consumer products between 2000 and 2017 across the United States. Data regarding the circumstances of FoBIs were abstracted from narrative data. Relationships among time, intent, demographics, and behavioral attributes were assessed using regression analyses, accounting for survey structure. Results Adult FoBIs have increased in incidence over the past 2 decades from 3 to 5.3 per 100,000 persons. Examination of consumer products revealed that jewelry (15.4%), nails (7.2%), and toothpicks (6.9%) were the most commonly ingested products. The most common products ingested varied over time, and the number of unique consumer product categories ingested increased from 103 to 143 in the time period studied. Intentional ingestions accounted for 14% of adult FoBIs and frequently involved plastic bagging (13.6%), batteries (13%), nails (10.1%), and desk supplies (6.8%). Adjusted regression analyses demonstrated that compared with accidental FoBIs, intentional FoBIs have increased over time. Intentional FoBIs were more frequently associated with younger age, substance abuse, police custody, and mental and cognitive illnesses relative to accidental FoBIs. Conclusions Our results indicate that adult FoBIs are an increasing burden of disease in the United States with social, psychiatric, and behavioral contributors to this trend.

Objective The aim of this study was to present our experience on the evaluation of suspected illicit drug carriers via computerized tomography scout view (CTSV) with analysis of detectability and features such as content, form and density. Methods A total of 120 individuals suspected of body packing were screened via CT in a university emergency department between January 2014 and December 2017. Results 88.3% of 120 body packing cases examined in the study were male. The median (1st quartile–3rd quartile) age of the cases was 35.5 (30–41) years. We found that solid packs have a 4.573-fold higher likelihood of detection in CTSV screening than liquid ones (95%CI: 1.879–11.134). Additionally, the number of CT scans needed were significantly associated with capsule localization (stomach) (OR:7.178, 95%CI: 2.420–21.293) and solid form packs (OR: 8.705, 95%CI: 2.318–32.692) are associated with number of CT scans. Conclusion CTSVs have a successful detection rate, especially in solid form packs. Our results suggest that conclusive CTSV imaging for body packing may be recommended to delay the application of the next CT scan until the passage of the first capsule; thereby preventing unnecessary radiation exposure.

Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.

“Body packers” are persons who voluntarily or through coercion, swallow or insert drug-filled packets into body cavity, generally in an attempt to smuggle them across secure borders. The drugs most often involved in body packing are heroin and cocaine. Body packers can present in the emergency department as a result of ruptured drug packets, bowel obstruction, or for medicolegal purposes. Suspected cases are diagnosed with X-ray and computed tomography scan of the abdomen. Symptomatic patients require urgent removal of packets. We present a case of foreign national male in whom a drug packet got ruptured and 49 other packets were retrieved with help of laxatives and manual evacuation.

Objectives It is difficult and time-consuming to detect narcotic drugs concealed within human bodies by visual assessment of X-ray images . This study aimed to describe a method for automatic detection of concealed drugs based on abdominal X-ray transmission images. Methods 43 X-ray images from suspects during border inspection are used in this study. Image features were extracted from both the directional fractal dimension and the gray level to form feature vectors. An unbalanced data preprocessing method was implemented before training to minimize the false alarms. A support vector machine model was applied for training and final classification. Results The proposed method yielded a 97.7% classification accuracy and a 96.1% sensitivity in 43 image cases, which were superior to the method without unbalanced data process resulting in a 95.3% classification accuracy and a 92.3% sensitivity. Conclusions This fast, computer-based X-ray transmission image processing method can be used in the field inspection for rapid, automatic detection of body packing.

The body packing represents an illegal drug trafficking practice across the borders of certain countries. It has experienced enormous growth in recent years. The medical literature is rich in publications interested in body packaging of cocaine or heroin with sometimes lethal consequences. However, reported cases of cannabis body packing appear to be rare, sometimes underestimated, despite the notoriety of cannabis in the illegal drug market and its wide consumption around the world. We report in this work a forensic case of a cannabis body packer deceased due toa stercoral peritonitis secondary to a double perforation of thesigmoid and rectal colon.

Opium is a substance extracted from Papaver somniferum L that is chronically abused specially in the traditional production regions. Reports on opium poisoning has largely disappeared from the occidental literature on drug problems but recent scientific articles show cases of death related to opium in industrialized countries. This fact led us to consider the interest of knowing the state of the art of acute opium intoxication in modern times. This work shows a compilation of these uncommon cases occurred in different settings and circumstances. Data were obtained by a computer assisted search of the literature using the key words "opium poisoning", "poppy", "poppy seeds", and "papaver somniferum" in PubMed, accompanied by a hand search of the reference lists of all articles for any relevant studies not included in the database. In addition, Google Scholar, government reports, and cases adequately documented on websites were reviewed. Type 1 cases, Accidental opium intoxications when it is used as a recreational drug: Reported cases came mainly from industrialized countries. They were mostly male with a range age of 17-64 years. Many had antecedents of alcoholism or drug abuse and opium tea was used as a substitute of heroin. Rachacha has caused poisonings in France and has been detected in a stash in Spain. Toxicological analysis was documented in forensic cases. The danger of this renewed interest in opium is exemplified in that many of the poisoning cases resulted in fatalities. Type 2 cases, Accidental opium intoxications in children or adults when it used as folk remedy: Pediatric intoxication after the use of opium as folk remedy are mainly published in traditional opium-producing areas with a long history of use or ethnic communities in England or USA. Addiction to opium was common among relatives. Type 3 cases, Opium intoxications with poppy seeds consumed as food: Due to excessive consumption of opium seeds as food, sporadic cases of mild toxicity had been reported and morphine contents were documented. Type 4 cases: Accidental opium intoxications when using the abdominal or pelvic cavity for concealing the drug: Accidental opium body packer intoxications are seen in patients who traveled from illegal opium areas of production. Type 5 cases: Suicides by opium: Opium was a prevalent agent among cases of suicides in Iran but data are scarce.

Ingestion of large amounts of cocaine packages is a well-known method for cross-border transportation. Intestinal obstruction and life-threatening sympathomimetic toxidrome including seizures, ventricular dysrhythmia, and cardiac arrest resulting from the rupture of cocaine packages may occur. Here, we report a case of a 34-year-old pregnant woman who had a sudden cardiac arrest while waiting for her bags at Paris-Charles de Gaulle Airport, France. According to the flight attendants, the patient travelled from Brazil and complained of abdominal pain during the flight. After resuscitation, the patient presented sustained tachycardia and convulsions suggesting cocaine overdose caused by body packing. Once admitted to the hospital, laparotomy was performed allowing the extraction of 50 cocaine packages. Cardiac symptoms were attributed to the rupture of five of the packages. Prehospital and emergency physicians need to be aware of the possibility of cocaine overdose by body packing in patients presenting sudden cardiac arrest in airports.

Intentional body dismemberment is usually associated with homicides. This chapter presents two unusual cases of postmortem body dismemberment following accidental deaths. The cases presented were accidental drug overdoses associated with body packing. Body packers are people who ingest packets of illicit drugs or insert them into body cavities for purposes of smuggling. Fatalities occur when these ingested packets accidentally leak or rupture. In the cases presented, accomplices cut the decedent’s bodies to remove the drugs and then dismembered the bodies for disposal. Annual trends of body packer fatalities in New York City are also presented.

Background Synthetic cannabinoid intoxication has become difficult to diagnose and manage in the United States, in part due to varying clinical effects within this heterogeneous group of compounds. Case Report A 38-year-old man was admitted with altered mental status and bradycardia. He demonstrated progressive encephalopathy, seizure activity, second-degree atrioventricular block type I, respiratory failure, hypotension, hypothermia, and hypoglycemia. A computed tomography scan of the abdomen and pelvis revealed multiple packages in the patient's stomach and rectum. Multiple attempts at gastrointestinal decontamination were unsuccessful. On hospital day 8 the patient developed hypertensive emergency and was taken to the operating room for exploratory laparotomy. Twenty-two poorly wrapped packages were removed from the bowel. Postoperatively the patient demonstrated both generalized and focal seizure activity. His mental status slowly returned to baseline over the period of about 1 week and he was ultimately discharged without neurological sequelae after 1 month. Analysis of patient serum, urine, and plant matter from the packages identified cannabis and 2.N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-indazole-3-carboxamide (ADB-FUBINACA). Why Should an Emergency Physician Be Aware of This? The case presented demonstrates the suspected toxidrome associated with severe ADB-FUBINACA intoxication, including mental status depression, bradycardia, autonomic instability, seizure, hypoglycemia, and hypothermia. Although the patient had simultaneous exposure to cannabis, his constellation of symptoms is not consistent with cannabis intoxication. A previous animal model supports the potential of this specific synthetic cannabinoid to cause the reported toxidrome.

Background Smuggling of illegal drugs by hiding them inside one’s own body, also called body packing, is a worldwide phenomenon. Cocaine is the most frequently transported drug. Body packing is a potentially lethal practice. The most serious complications of body packing are gastrointestinal obstruction or perforation and drug toxicity due to packet leakage or rupture. Case presentation A 30-year-old confirmed body packer was brought to our emergency department from jail because of agitation and mydriasis. He presented with a high respiratory rate of 40/min but normal oxygen saturation on ambient air, a heart rate of 116 bpm, a blood pressure of 116/68 mmHg and a temperature of 38.0° Celsius. Blood tests were suggestive of infection, urine analysis was positive for cocaine. Abdominal and thoracic computed tomography scans showed pulmonary infiltrates as a possible focus of infection; signs of bowel obstruction or perforation were absent. Given his clinical presentation, we suspected severe infection rather than massive cocaine intoxication to be the main problem. We therefore withheld immediate surgical decontamination. Instead, we started broad-spectrum antibiotic treatment with piperacillin/tazobactam plus clarithromycin for suspected severe community-acquired pneumonia or abdominal sepsis and treated the patient with intravenous midazolam for symptomatic cocaine intoxication. After detection of urinary pneumococcal antigen, the antibacterial regimen was changed to ceftriaxone and vancomycin for pneumococcal pneumonia. In addition, we found human immunodeficiency virus (HIV) type 1 infection as underlying disease. The patient recovered from his acute illness and was discharged after 7 days of treatment with ceftriaxone plus vancomycin. Antiretroviral therapy was started in an outpatient setting. Conclusions With this case report, we emphasize the need to look for alternative diagnoses to intoxication and gastrointestinal obstruction in acutely ill body packers with atypical presentation. Special risks, such as underlying HIV infection and potential antimicrobial resistance according to the individual’s geographical origin, should be taken into account while treating these patients.

Managing body packers and stuffers is a challenge to emergency physicians, stuffers in particular, as there is no systematic approach to their treatment. The aim of this study was therefore to review all available literature on body stuffing and propose a guide to manage these patients. We searched Medline/PubMed, Google Scholar, and Scopus for published work on body stuffers using key words “body stuffer”, “body stuffing”, “poisoning”, “toxicity”, and “treatment” without a time limit and retrieved 290 articles, of which 61 remained after exclusion of those on “body packers” and repetitive documents. This review article evaluates and summarises the information gathered from them. The main step in body stuffer management is observation to make sure that they have passed all the swallowed packages of drugs of abuse. In some cases, imaging can be quite useful. Diagnostic pitfalls may be avoided with abdominopelvic CT without contrast, which is probably the best diagnostic method to determine the presence and the number of packages in these patients. Treatment should be specific for each group of drugs, whether it is opioids, cocaine, or amphetamine. Surgical interventions are indicated for obstruction of the intestines or package rupture. Legal precautions should be taken because of the legal complexity of body stuffing cases., Medicinska obrada osoba koje su progutale ili u tijelu skrivaju pakete s opojnim sredstvima veliki je izazov liječnicima na odjelu hitne pomoći. Razlikuju se osobe koje su pakete (vrećice, ampule) progutali s namjerom da ih prokrijumčare (tzv. mule ili body packers) i one koje su progutale pakiranja u strahu da ne budu uhvaćeni s drogom (tzv. body stuffers). U potonjem je slučaju riječ o manjim količinama, ali mnogo slabije upakiranih tvari, zbog čega može doći do puknuća omota, curenja njegova sadržaja u tijelo, predoziranja i smrti. Svrha je ovoga istraživanja bila napraviti pregled dostupne literature upravo o toj rizičnoj skupini i predložiti standardnu obradu takvih pacijenata. Za pretragu su korišteni web pretraživači znanstvenih radova Medline/Pubmed, Google Scholar i Scopus pomoću ključnih riječi “body stuffer”, “body stuffing”, “poisoning” (trovanje), “toxicity” (toksičnost) i “treatment” (liječenje) bez vremenskog ograničenja objavljivanja. Pretraga je izbacila 290 članaka, od kojih su izuzeti oni koji se odnose na body packers i oni koji se ponavljaju. Stoga se ovaj pregledni rad u konačnici oslanja na korisne informacije dobivene iz 61 relevantnog članka o toj temi. Najvažniji je korak pri obradi body stuffera promatranje i praćenje, kako bismo bili sigurni da su izbacili iz tijela sve progutane pakete s opojnim drogama. U pojedinim slučajevima tehnike snimanja mogu se pokazati veoma korisnima. Dijagnostičke zamke koje obično daju lažno negativne rezultate mogu se izbjeći beskontrastnom kompjutorskom tomografijom (CT-om) područja trbuha i zdjelice, kao ponajboljom metodom za utvrđivanje postojanja i broja paketića u tih pacijenata. Liječenje treba biti prilagođeno vrsti droge, budući da opioidi, kokain odnosno amfetamin, zahtijevaju različitu obradu. Kirurške su intervencije indicirane kod opstrukcije crijeva ili puknuća paketa. Također valja imati na umu zakonske implikacije zbog kaznene naravi skrivanja droga u tijelu.

Highlights • The incidence of body packing of illicit drugs is on the rise. • Radiography is crucial in the diagnosis of body packing. • Arrhythmia, seizures, and respiratory depression can complicate perioperative care. • Surgical intervention is necessary for those with signs and symptoms of bowel obstruction or drug overdose., Introduction Body packing is the use of intra-corporeal packages of illicit drugs for the purpose of smuggling, usually through customs. Clinical cases and experience with body packers has increased since the first report appeared in 1971. These cases remain an uncommon cause of acute drug toxicity and/or bowel obstruction. Presentation of case A 23 year-old man was brought to the emergency department with seizures. CT imaging revealed numerous intestinal foreign bodies, suspicious for body packing. The patient was stabilized and taken emergently to the operating room for exploratory laparotomy and removal of 34 cocaine packets. Ongoing treatment for cocaine overdose was also utilized. The patient recovered without complications. Discussion This case provides insight and awareness for proper diagnosis and management of body packers by physicians and surgeons alike. Conclusion We present a case report of acute cocaine intoxication in a young man who ingested 34 packets of cocaine for means of drug trafficking. Medical approaches are available for cases in which patients remain asymptomatic, but surgical intervention is necessary for those with signs and symptoms of bowel obstruction or drug overdose.

Background To evaluate the detection rate and image quality in CT-body-packer-screening at different radiation-dose levels and to determine a dose threshold that enables a reliable detection of incorporated body packs and incidental findings with a maximum of dose saving. Materials and methods We retrospectively included 27 individuals who underwent an abdominal CT with automated exposure control due to suspected body packing. CT images were reconstructed at different radiation-dose levels of 50%, 10, 5% and 1% using iterative reconstructions. All 135 CT reconstructions were evaluated by three independent readers. Reviewers determined the presence of foreign bodies and evaluated the image quality using a 5-point ranking scale. In addition, visualization of incidental findings was assessed. Results A threshold of 5% (effective dose 0.11 ± 0.07 mSv) was necessary to correctly identify all 27 patients with suspected body packing. Extensive noise insertion to a dose level of 1% (0.02 ± 0.01 mSV) led to false-positive solid cocaine findings in three patients. Image quality was comparable between 100 and 50%. The threshold for correct identification of incidental findings was 10% of the initial dose (effective dose 0.21 ± 0.13 mSv). Conclusions Our results indicate that dose of abdominal CT for the detection of intracorporeal cocaine body packets can be markedly reduced to up to 5% of the initial dose while still providing sufficient image quality to detect ingested body packets. However, a minimum effective dose of 0.21 mSv (10% of initial dose) seems to be required to properly identify incidental findings.

Internal concealment and transportation of illegal substances by body packing is a major business with very high profits, attracting criminals all over the world. As body packers are rarely arrested, it is difficult to quantify their proportion in the general population and, consequently, identify the countries involved in this kind of drug traffic; as a consequence, the percentage of undetected cases is undoubtedly high. The aim of this study is to provide useful information concerning the country of origin of body packers travelling to Italy through the analysis of the United Nations Office on Drugs and Crime Individual Drug Seizures Report database in the period 2010–2015. Results of our study highlighted a total of 85 cases, producing a total of 52.4 kg of drugs transported through body packing towards Italy. Data obtained from our analysis could represent an useful starting point to: (a) enhance police controls on people coming from targeted countries and improve collaborations between Italian Police Forces and those of other countries; (b) understand the reason why some cities/airports are so frequently used in drug trafficking through body packing and, as a consequence, enhance police controls in these places; and (c) train airport security staffs in international airports recognized as important departure points for body packers travelling to Italy.

Body packing is the term used for the intracorporeal concealment of illicit drugs, mainly cocaine, heroin, methamphetamine, and cannabinoids. These drugs are produced in the form of packages and are swallowed or placed in various anatomical cavities and body orifices. Basing on these two ways of transportation a distinction between body stuffers and body pushers can be made, with the former described as drug users or street dealers who usually carry small amounts of drugs and the latter as professional drug couriers who carry greater amounts of drugs. A review of the literature regarding body packing is presented, with the aim to highlight the toxicological and radiological features related to this illegal practice. Raising awareness about the encountered mean body levels of the drugs and the typical imaging signs of the incorporated packages could be useful for clinicians and forensic pathologists to (a) identify possible unrecognized cases of body packing and (b) prevent the serious health consequences and deaths frequently occurring after the packages' leakage or rupture or the packages' mass obstructing the gastrointestinal lumen.

Body packing is the ingestion or insertion in the human body of packed illicit substances. Over the last 20 years, drug smuggling has increased global and new means of transport of narcotics have emerged. Among these, the most frequent one is the gastrointestinal tract: from mouth to anus, vagina, and ears. Cocaine is one of the most traded drugs, followed by heroin. Condoms, latex gloves, and balloons are typically used as drug packets for retention in the body. There are different radiologic modalities to detect illicit drugs in body packing: Plain radiography, computed tomography (CT), ultrasound, and magnetic resonance. Current protocols recommend the use of radiography to confirm packet retention and, in case of doubt, the use of abdominal CT scan with reduced mAs. In case of packet rupture, catastrophic effects can occur. Management of patients carrying packets of drugs is a recurrent medico-legal problem. To improve diagnostic accuracy and prevent hazardous complications, radiologists and emergency physicians should be familiar with radiologic features of body packing. The radiologist plays both a social and a medico-legal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location. In this review, we focus on diagnostic errors and medico-legal issues related to the radiological assessment of body packers.

The aim of this study was to evaluate the impact of a reduced tube potential (100 kVp) for non-enhanced abdominal low-dose CT on radiation dose and image quality (IQ) in the detection of body packing. This retrospective study was approved by the local research ethics committee of our clinic. From March 2012 to July 2014, 99 subjects were referred to our institute with suspected body packing. 50 CT scans were performed using a 120 kVp protocol (group A), and 49 CTs were performed using a low-dose protocol with a tube voltage of 100 kVp (group B). Subjective and objective IQ were assessed. DLP and CTDIvol were analyzed. All examinations were of diagnostic IQ. Objective IQ was not significantly different between the 120 kVp and 100 kVp protocol. Mean density of solid and liquid body packets was 210 ± 60.2 HU at 120 kVp and 250.6 ± 29.7 HU at 100 kVp. Radiation dose was significantly lower in group B as compared to group A (p

A 39-year-old man died of multi-organ failure complicating mixed drug toxicity that included methadone, oxazepam, oxycodone and nitrazepam. His past medical history involved alcohol and poly-substance abuse with chronic self-harm and suicidal ideation. There had been multiple hospital admissions for drug overdoses. At autopsy the most unusual finding was of two packages of 10 tablets each, wrapped in thin plastic film within the rectum. The insertion of drugs into body orifices and cavities has been termed body pushing to distinguish it from body packing where illicit drugs are wrapped and swallowed for transport and smuggling, and body stuffing where small amounts of loosely wrapped or unwrapped drugs are swallowed to conceal evidence from police. This case demonstrates that body pushing may not always involve illicit drugs or attempted concealment from police or customs officials. It appears that the drugs had been hidden to ensure an additional supply during the time of residence in hospital. The extent to which body pushing is currently being used by patients to smuggle drugs into secure medical facilities is yet to be determined.

© 2018 The Author(s). Background: Drug dealers and drug users resort to body stuffing to hastily conceal illicit drugs by ingesting their drug packets. This practice represents a medical challenge because rupture of the often insecure packaging can be toxic and even lethal. In an emergency setting, official guidelines are needed to help the medical team decide on the proper treatment. A preliminary observation period is generally accepted but its duration varies from hours to eventual packet expulsion. Case presentation: This case involves a 20-year-old white man in detention who claimed to have ingested one cocaine packet wrapped in plastic food-wrap and a condom in anticipation of an impending cell search. He reached out to medical professionals on day 4 after having unsuccessfully tried several methods to expel the drug packet, including swallowing olive oil, natural laxatives, liters of water, and 12 carved apple chunks. An initial computed tomography scan confirmed multiple packet-sized images throughout his stomach and bowel. After 24 hours of observation and normal bowel movements without expelling any packets, a subsequent scan found only one air-lined packet afloat in the gastric content. Due to the prolonged retention of the package there was an increased risk of rupture. The packet was eventually removed by laparoscopic gastrotomy. Conclusions: This case report illustrates that observation time needs to be adapted to each individual case of body stuffing. Proof of complete drug package evacuation ensures secure patient discharge. Body stuffers should be routinely asked for a detailed history, including how the drug is wrapped, and whether or not they ingested other substances to help expel the packets. The history enables the accurate interpretation of imaging. Repeated imaging can help follow the progress of packets if not all have been expelled during the observation period. Drug packets should be surgically removed in case of prolonged retention. To ensure the best possible outcomes, patients should have access to high-quality, private, and confidential medical care, which is equal to that offered to the general population. This is paramount to earning trust and collaboration from people in detention who resort to body stuffing.