A Curious Case of the Persistent Body Stuffer

A 29-year-old male presented to our emergency department with complaint of abdominal pain after allegedly ingesting a 4-gram packet of heroin in an attempt to evade detection. Initial evaluation including computed tomography (CT) of the abdomen/pelvis with intravenous and oral contrast, as well as laboratory workup was negative and the patient was discharged. The patient returned 3 days later with complaint of “I feel high” and severe constipation, and demonstrated an opiate toxidrome requiring naloxone with improvement of symptoms. A repeat CT of the abdomen/pelvis, this time without contrast revealed a 2.1 × 1.8 cm foreign body in the gastric antrum. The patient was promptly taken to endoscopy with surgical backup. Foreign body removal included multiple plastic bags encasing heroin, which had sustained a small leak causing a gastric outlet obstruction as well as a slow opiate toxidrome. The foreign body was removed and the patient was observed and discharged with a favorable outcome.

Management recommendations for body stuffers at emergency units

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.

Body-Packer & Body-Stuffer – eine medizinische Herausforderung

Seit den siebziger Jahren ist die westliche Welt in steigendem Masse von intrakorporalem Drogentransport betroffen. Das Ziel dieser Arbeit ist es, einen Algorithmus für ein sicheres Management von intrakorporalem Drogentransport anhand der gemachten Erfahrungen und der aktuellen Evidenz zu präsentieren. Es handelt sich um eine retrospektive Untersuchung, mittels der die Erfahrungen von vier Jahren im Spitalgefängnis analysiert und diskutiert werden. Erfasst wurden 34 Patienten in 37 Hospitalisationen im Zeitraum von 48 Monaten. Bei 28 Patienten konnten Drogenpakete nachgewiesen werden. Zwei Patienten erlitten schwerwiegende Komplikationen. Das Befolgen des hier empfohlenen Management-Algorithmus unterstützt das Handeln sowohl nach klinischer Erfahrung als auch nach evidenz-basierten Prinzipien der Medizin zum Risikomanagement, zur Qualitätssicherung und zur Förderung der Patientensicherheit.