Fatality in a body packer: the first reported case in Saudi Arabia

Background Body packers use different methods and materials to pack drugs inside their bodies. These could be simple or sophisticated to ensure a successful transfer or concealment of the drug with minimal risk to the packer. Different drugs were reported with cocaine and heroin being the most common. The packer presents to health facilities whenever they develop complications like drug leakage or intestinal obstruction, or they can be detected after a fatal event as an incidental finding in autopsy. Case presentation A body packer who was in detention suffered pain and died shortly after that. The autopsy not only revealed severe coronary atherosclerosis but also unveiled 10 rubber packages filled with methamphetamine and cannabis, and one package was found ruptured in the mouth. Toxicological analysis showed a blood level of methamphetamine 3.66 mg/L which was considered a cause of death. While methamphetamine was reported in cases of body packers, cannabis is rarely concealed by body packers for several reasons including its cost compared to the risk of packing. Conclusions This is the first reported case of fatality in body packers in Saudi Arabia and Arab countries. This should put into consideration the need for screening suspicious cases who are involved or suspected to be involved with drugs. Effective screening in specific facilities is needed to reduce fatalities and at the same time lowering drug smuggling.

EP.FRI.306 The Mule who took us for a ride

Introduction Foreign body ingestion is not uncommon in patients with mental disorders, alcohol intoxication and for purposes of drug trafficking. Small objects pass spontaneously; however, larger ones may get stuck in the oesophagus, stomach or at narrow areas of the bowel. "Body packers" is a term used to describe persons who swallow or insert drug-filled packets into a body cavity. They are also called “swallowers”, “internal carriers” “couriers” or “mules”. Case report We report a 37 year old previous drug abuser who presented with dysphagia. Upper GI endoscopy showed an oblong foreign body covered in plastic in the lower oesophagus. This could not be extracted and hence was pushed into the stomach. Three weeks later, he presented with bowel obstruction that was shown on abdominal radiograph and confirmed by CT indicating multiple dilated small bowel loops with a transition point in the terminal ileum where the ingested package was identified. The package was then removed through a longitudinal enterotomy. Conclusion Ingested foreign bodies causing dysphagia should ideally be extracted endoscopically. If not possible, then a watch and wait policy may be justified. While most ingested objects pass spontaneously, unusual and larger ones may require surgical extraction. The contents, nature and reason for ingesting this strange object remain a mystery. With history of drug abuse and the consistent denial of knowingly swallowing that object, we can only conclude that the patient was trying to transport an illicit drug in the packet. Keywords Foreign body ingestion, bowel obstruction, body packers.

Suspicious Case of a Body packer “Mule” in a Low Resource Country: A Case Report

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.

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones and Beyond

Introduction: Body packing is the smuggling of drugs and other contents inside the human body. However, non-narcotic contents studies are limited to rare case reports in literature. Thus, the objective of this study was to investigate cases of body packers in Brazil considering narcotic and non-narcotic contents. Methods: Retrospective study analyzing the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil. Results: Ten cases of body packing were observed. Only 50% of the patients carried drugs, while surprisingly, 70% carried non-content, especially cell phones and accessories. All the patients were male, prisoners and young adults. In 60%, there were gastrointestinal obstruction and in 30%, there was acute narcotic intoxication. Abdominal radiography was enough for diagnosis in 80% of the cases. In 90% of the cases, emergency laparotomy was required, but 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. Emergency surgery 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.

Demography and Mortality of Body Packers; an Extended Experience from a Referral Center

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.

Toxicology

This chapter in the Oxford Handbook of Emergency Medicine encompasses toxicology in the emergency department (ED). It examines poisons in general, including diagnosis, supportive care, reducing absorption, and antidotes. Specific poisoning is explored in detail, through opioid, salicylate, paracetamol, tricyclic antidepressant, benzodiazepine, clomethiazole, phenothiazine, barbiturate, lithium, sulfonylurea, beta-blocker, calcium channel antagonist, digoxin, angiotensin-converting enzyme (ACE) inhibitor, theophylline, salbutamol, iron, ethanol, methanol, ethylene glycol, paraquat, petrol, paraffin, organophosphate, cyanide, carbon monoxide, chlorine, and CS gas (tear gas) poisoning. Chemical incidents are discussed, as well as accidental poisoning from plants, berries, mushrooms, and button batteries. It also examines novel psychoactive substances (NPS), recreational drugs, serotonin syndrome, and body packers.

Body pack in sick bodies: a retrospective study of somatic and psychiatric comorbidities among body-packers

Purpose Body-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/approach A 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. Findings Body-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/value Body-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.