ArticlePDF Available

Apple, condom, and cocaine - Body stuffing in prison: A case report

Authors:

Abstract and Figures

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.
This content is subject to copyright. Terms and conditions apply.
C A S E R E P O R T Open Access
Apple, condom, and cocaine body
stuffing in prison: a case report
Benedicte Jalbert
1
, Nguyen Toan Tran
2*
, Stephan von Düring
1
, Pierre-Alexandre Poletti
3
, Ian Fournier
4
,
Catherine Hafner
1
, Celestine Dubost
2
, Laurent Gétaz
2
and Hans Wolff
2
Abstract
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
cocainepacketwrappedinplasticfood-wrapandacondominanticipationofanimpendingcellsearch.Hereachedout
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.
Keywords: Body stuffing, Prison, Cocaine, Condom, Apple, Gastric retention, Radiology pitfalls
Background
Body stuffers, who are at the end of the drug trafficking
chain as community drug dealers or consumers, swallow
the few drug packets that they have on hand (mostly
cocaine and heroin) to conceal them from law enforce-
ment in anticipation of impending searches or arrest [1].
In contrast, body packers usually ingest a large number
of mechanically manufactured compact drug packets
enclosed in multiple layers of wrapping to resist rupture
during long-distance drug smuggling [2].
When taken to a medical facility, an unenhanced com-
puted tomography (CT) scan is usually preformed and is
preferred to conventional X-ray for confirmation of the
diagnosis [35]. Body stuffers are then usually observed
for a few hours and released if no complications occur
[6]. However, the required duration of the observation is
still debated with some authors recommending
discharge after 6 hours of unremarkable observation,
and others recommending a conservative approach,
which consists of waiting for the evacuation of the drug
packets by unaided bowel movements (no medication,
* Correspondence: Nguyen-Toan.Tran@hcuge.ch
Equal contributors
2
Division of Prison Health, Geneva University Hospitals and Faculty of
Medicine, University of Geneva, Geneva, Switzerland
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Jalbert et al. Journal of Medical Case Reports (2018) 12:35
DOI 10.1186/s13256-018-1572-8
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
such as prokinetic agents or laxatives) [7,8]. The use of
oil-based laxatives is not recommended as it can cause
packet rupture due to a chemical reaction with latex [9].
However, if patients do not spontaneously expel the
packets after a few days, especially if these were loosely
wrapped and not intended for internal concealment,
they will require further medical attention due to the in-
creased risk of rupture. This is true even if reported
body stuffer fatalities are rare and the quantity of
ingested drugs is usually less than that of body packers
[1012]. However, packet rupture is dangerous and can
be lethal [13,14]. Surgery is the recommended choice to
safely remove retained drug packets versus endoscopy in
which the manipulation of packets increases the risk of
rupture [1517].
We present this case report to shed light on some of
the particular and confusing circumstances that can be
found when managing body stuffers. Our report demon-
strates that a 6-hour observation period can be insuffi-
cient and that CT findings must be correlated with the
patients story in order to determine the severity of the
situation.
Case presentation
This case involves a 20-year-old healthy white man in-
carcerated in a detention center in Geneva, Switzerland.
He had no medical or mental health conditions and did
not take any medication. He has two older siblings, had
dropped out of school at a young age, and was living
with his mother at the time of incarceration. He used to
smoke tobacco and cannabis, which he stopped 2 years
ago, consumed cocaine and ecstasy (methylene-dioxy-
methamphetamine) until 6 months before his incarcer-
ation, and drank alcohol occasionally without reporting
any binge drinking. Due to a recent trauma to his left
wrist, he was accompanied to our University Hospital
for an X-ray. Once in Radiology, he confessed to the
technician that he had ingested an illicit drug packet 4
days earlier in anticipation of an impending cell search.
The drug packet was reportedly 4 to 5 cm in size, con-
tained 6 to 8 g of cocaine, and was wrapped in a condom
and plastic food-wrap. He was worried because he had
not yet evacuated the packet and had been experiencing
mild epigastric pain for a few hours before his x-ray
appointment. He did not have any other gastrointestinal
(GI) symptoms, including nausea, vomiting, diarrhea,
and constipation. After the wrist X-ray he was taken to
our Emergency Department (ED) for the management of
the body stuffing. On admission, his vital signs were as
follows: blood pressure of 131/60 mmHg, heart rate of
74 beats/minute, and temperature of 37.6 °C. He was
alert, oriented, calm, and expressed no intention of self-
harm. A physical examination revealed epigastric tender-
ness, but no abdominal rigidity, guarding, rebound
tenderness, or evidence of a palpable mass. The rest of
the examination was unremarkable, including a cardio-
pulmonary and a complete neurological examination.
Laboratory findings were within normal range, including
a complete blood count (hemoglobin of 16.2 g/dL, white
cell count of 8.5 G/L, platelet count of 121 G/L), kidney
and liver function tests, and a urine analysis. Tests for
HIV and hepatitis B were negative. He returned to our
Radiology Department where a low-dose abdominal CT
scan was performed and revealed multiple foreign bodies
of similar aspect throughout his stomach, his duodenum,
and his small intestine, all of which were consistent with
packets of loosely aggregated drugs (Fig. 1a). There was
no sign of GI perforation or obstruction.
He was subsequently admitted to our in-patient
Carceral Unit for observation. When confronted with
the radiology findings of multiple foreign bodies he
Fig. 1 aMultiple intradigestive foreign bodies (arrows) situated in the
stomach, the duodenum, and small intestine on computed tomography
(coronal view). bSingle heterogeneous foreign body (arrow)containing
air measuring 3.1 × 3.2 × 4 cm located in the stomach on computed
tomography (axial view)
Jalbert et al. Journal of Medical Case Reports (2018) 12:35 Page 2 of 5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
insisted on having swallowed only one drug packet.
Further exploration revealed that he used various GI-sti-
mulating techniques which had been recommended by
his fellow inmates to accelerate the expulsion of his
slow-progressing packet. These included drinking large
quantities of water (more than 3 L daily), ingesting three
to four tablespoons of olive oil daily, a cupful of natural
fig-based laxative, and applying warm towels on his
liver.On day 3 after the packet ingestion and as a last
resort, he carved and ingested 12 bite-sized apple
chunks with the hope that together they would push the
packet through his GI system. Despite all these attempts,
he continued to have regular bowel movements once
daily without evacuating the packet. The fear of a
complication compelled him to seize the opportunity of
being brought to the X-ray room to reveal the circum-
stances of his condition to the radiology technician.
Since the apple chunks could have been interpreted as
images of loosely compacted drug packets, a second
low-dose CT scan was performed the day after his ad-
mission (day 5 post-ingestion): the apple chunks were
partially digested and the images showed the persistence
in his stomach of one foreign body containing air and
measuring 3.1 × 3.2 × 4 cm (Fig. 1b).
Since the packet had been trapped in his stomach for
the past 5 days, the condom wrapping was likely to have
been compromised by gastric acidity, thus increasing the
risk of rupture. Therefore, a proton pump inhibitor
(PPI) of esomeprazole was administered intravenously.
After discussing management options with our patient,
GI specialists recommended using surgery rather than
gastric endoscopy in order to extract the drug packet
with a minimum of risk. A laparoscopic gastrotomy
confirmed a floating packet in the gastric fluid which
was removed without complications (Fig. 2). Analysis of
the packet after retrieval confirmed that the drug was
cocaine. The packet was loosely wrapped in two differ-
ent materials: a first double layer of plastic food-wrap
inserted into a condom which was tied with a knot and
folded back to form another layer and secured with an
outer knot (Figs. 3and 4).
He presented a transitory fever up to 38.8 °C at
48-hours post-surgery but otherwise maintained normal
vital signs. He resumed oral intake shortly after surgery
and continued the PPI treatment for 2 weeks after
surgery to aid healing. He was discharged back to prison
on day 4 post-surgery. An out-patient follow-up in the
prison health service was unremarkable. He was released
from detention 2 months after surgery and further
follow-up was not possible.
Discussion
This is the case of a 20-year-old man who ingested apple
chunks to help with the expulsion of a cocaine packet,
which was eventually removed by laparoscopic gastrot-
omy. It illustrates several points that are necessary to
consider for the management of body stuffers.
First, contrary to the recommendations of Yamamoto
et al., an adequate observation time in a medical setting
is necessary even if body stuffers do not show signs of
complication during the first 6 hours following packet
ingestion [7]. Body stuffers often resort to precarious
packaging for hasty concealment. Therefore, care must
be organized around this point. They present an
increased risk of packet rupture and unpredictable pro-
gression through the digestive system resulting in the
possibility of delayed toxicity even if no signs of toxicity
are observed within the first 6 hours post-ingestion. This
Fig. 2 Gastrotomy by laparoscopy showing the packet floating in
the stomach (blue arrow)
Fig. 3 Drug packet tied in a condom with an internal knot (white arrow);
the second layer of the condom which was folded back to form another
protective layer and tied with an outer knot (blue arrow)wascutopen
and pulled to the left (yellow arrow)
Jalbert et al. Journal of Medical Case Reports (2018) 12:35 Page 3 of 5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
case shows that loosely aggregated drugs within a poorly
wrapped package with trapped air between the different
layers may not have the sufficient density to descend
and engage into the pylorus. This is compounded if the
patient drinks large amounts of fluids which may facili-
tate normal transit but will keep the packet buoyant in
the stomach. A premature discharge of our patient from
the hospital could have resulted in poor outcomes and
even death (the estimated weight of 6 to 8 g of cocaine,
even with admixture, surpasses the minimum lethal dose
of 1.2 g of pure cocaine) [10]. Until now, no official
guidelines have been set to determine the correct
duration of surveillance of body stuffers. Therefore, we
believe that it is essential to incorporate the influence of
these different technical parameters into the duration of
the observation time and discuss with the patient the
risks and benefits of a prolonged surveillance to deter-
mine the most appropriate course of action.
Second, localizing the number, location, and progres-
sion of packets is necessary for clinical management.
The detection of internal drug packets must be per-
formed by low-dose CT without contrast rather than by
conventional X-ray as CT is superior in providing an ac-
curate and reliable detection of different densities, from
low-density to high-density packets and different dens-
ities of drug aggregation [18]. However, there can be
pitfalls due to foreign bodies of similar density, especially
if located in the stomach, which can mimic the images
of drug packets, as was the case with the pieces of apple
in our case study. The literature reports other swallowed
foreign bodies that can resemble drug packets, including
scybala (hardened masses of feces), grains, stones, or
fruits [19]. A way to differentiate the nature of the in-
gesta would be to measure the Hounsfield unit on CT,
which reflects density. However, density measurements
are not completely reliable as the nature of the
substance, such as its purity, admixture, and compres-
sion, plays a major role in imaging [18]. Therefore, body
stuffers should be routinely asked whether they ingested
other substances to help expel the packages and their
history should help interpret the CT images.
Third, latex wrapping warrants some attention. Latex
condoms can be used for packaging drugs in body stuff-
ing and less rarely in body packing, where packages are
generally manufactured mechanically to ensure robust-
ness. It is well documented that oil-based lubricants
have an adverse effect on the physical properties of latex
condoms (tensile strength, break at elongation, burst
pressure, and volume), which can result in their rupture
[9]. Such lubricants are found in laxatives, which is the
reason their use is not routinely recommended for accel-
erating the evacuation of drug packets. Gastric juices are
extremely corrosive due to their acidity. Therefore,
neutralizing the acidity with a PPI appeared to be an em-
pirically safe way to delay the corrosion and rupture of a
condom-wrapped package trapped in the stomach.
However, surgical management in our case was the
safest option.
Fourth, body stuffers usually do not trust authorities
and are not prone to admitting their drug concealment
to anybody. Therefore, they are at increased risk of
complications, even more so if they are already in deten-
tion. The Geneva University Hospitals have a long-held
tradition of providing health services in the detention
centers in the canton of Geneva. These services are in-
dependent of the judiciary and prison system and are
guided by a human rights-based approach to guarantee
free access to a health care provider, equivalence of care,
and patients consent and confidentiality [20]. The re-
spect of these principles gives confidence to people
living in detention toward health care professionals: it
enables them to seek help that they trust whenever
needed. In our case, the patient reached out to a radi-
ology technician (and not to a prison staff member), and
collaborated with the ED and in-patient medical team,
knowing that the circumstances of his medical interven-
tion would be known only to the medical team and
would not be divulged to the penal authorities.
Conclusions
This case report illustrates that sufficient observation
time in an appropriate medical setting is essential for
patients presenting with drug body stuffing. Complete
drug package evacuation ensures secure patient dis-
charge. A detailed history is fundamental in body
stuffers, including how the drug is wrapped, and whether
or not other substances were ingested to help expel the
packets. The history must be taken into account in the
careful interpretation of CT images, and imaging should
be repeated if the progression of the packets is in doubt.
Fig. 4 Unwrapped drug packet from a double layer of plastic food-wrap
with a positive cocaine identification (in blue)
Jalbert et al. Journal of Medical Case Reports (2018) 12:35 Page 4 of 5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Drug packets should be surgically removed in case of
retention. To ensure the best possible outcomes, provid-
ing access to private, confidential, and high-quality med-
ical care, which is equal to the care offered to the
general population, is paramount to gain trust and
collaboration from people in detention who resort to
body stuffing.
Abbreviations
CT: Computed tomography; ED: Emergency Department; GI: Gastrointestinal;
PPI: Proton pump inhibitor
Acknowledgements
None.
Funding
No funding was received for this study.
Availability of data and materials
All data generated or analyzed during this study are included in this published
article.
Authorscontributions
BJ wrote the first draft of the manuscript. SVD, CH, CD, IF, and NTT were in
charge of clinical patient care. PP supervised and interpreted the radiological
examinations. NTT, SVD, LG, and HW reviewed the manuscript. All authors read
and approved the final manuscript.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Written informed consent was obtained from the patient for publication of this
case report and any accompanying images. A copy of the written consent is
available for review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
PublishersNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Department of General Internal Medicine, Geneva University Hospitals and
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
2
Division of
Prison Health, Geneva University Hospitals and Faculty of Medicine,
University of Geneva, Geneva, Switzerland.
3
Department of Radiology,
Geneva University Hospitals and Faculty of Medicine, University of Geneva,
Geneva, Switzerland.
4
Department of Visceral Surgery, Geneva University
Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Received: 6 November 2017 Accepted: 12 January 2018
References
1. Traub SJ, Hoffman RS, Nelson LS. Body Packing The Internal
Concealment of Illicit Drugs. NEJM. 2003;349:251926.
2. Pidoto RR, Agliata AM, Bertolini R, Mainini A, Rossi G, Giani G. A new
method of packaging cocaine for international traffic and implications for
the management of cocaine body packers. J Emerg Med. 2002;23:14953.
3. Shahnazi M, Hassanian Moghaddam H, Gachkar L, Ahmadi N, Zamani N,
Bahrami Motlagh H, et al. Comparison of abdominal computed tomography
with and without oral contrast in diagnosis of body packers and body
stuffers. Clin Toxicol. 2015;53:596603.
4. Sica G, Guida F, Bocchini G, Iaselli F, Iadevito I, Scaglione M. Imaging of
Drug Smuggling by Body Packing. Semin Ultrasound CT MR. 2015;36:3947.
5. Schmidt S, Hugli O, Rizzo E, Lepori D, Gudinchet F, Yersin B, et al. Detection
of ingested cocaine-filled packetsDiagnostic value of unenhanced CT. Eur
J Radiol. 2008;67:1338.
6. Moreira M, Buchanan J, Heard K. Validation of a 6-hour observation period
for cocaine body stuffers. Am J Emerg Med. 2011;29:299303.
7. Yamamoto T, Malavasi E, Archer JRH, Dargan PI, Wood DM. Management of
body stuffers presenting to the emergency department. Eur J Emerg Med.
2016;23:4259.
8. Wightman RS, Nelson LS. Has the die been cast? Discharge of body stuffers
from the Emergency Department. Eur J Emerg Med. 2017;24:76.
9. White N. Dangers of lubricants used with condoms. Nature. 1988;335:19.
10. Fineschi V, Centini F, Monciotti F, Turillazzi E. The cocaine body stuffer
syndrome: a fatal case. Forensic Sci Int. 2002;126:710.
11. Norfolk GA. The fatal case of a cocaine body-stuffer and a literature review
towards evidence based management. J Forensic Legal Med. 2007;14:4952.
12. Booker RJ, Smith JE, Rodger MP. Packers, pushers and stuffers managing
patients with concealed drugs in UK emergency departments: a clinical and
medicolegal review. Emerg Med J. 2009;26:31620.
13. Havis S, Best D, Carter J. Concealment of drugs by police detainees: Lessons
learned from adverse incidents and from routineclinical practice. J Clin
Forensic Med. 2005;12:23741.
14. Kelly J, Corrigan M, Cahill RA, Redmond HP. Contemporary management of
drug-packers. World J Emerg Surg. 2007;2:9.
15. Macedo G, Ribeiro T. Esophageal obstruction and endoscopic removal of a
cocaine packet. Am J Gastroenterol. 2001;96:16567.
16. Shabani M, Zamani N, Hassanian MH. Endoscopic retrieval of baggies in
body stuffers. Endosc Int Open. 2016;4:E4435.
17. Beauverd Y, Poletti P-A, Wolff H, Ris F, Dumonceau J-M, Elger BS. A body-
packer with a cocaine bag stuck in the stomach. World J Radiol. 2011;3:1558.
18. Flach PM, Ross SG, Ampanozi G, Ebert L, Germerott T, Hatch GM, et al.
Drug mulesas a radiological challenge: Sensitivity and specificity in
identifying internal cocaine in body packers, body pushers and body
stuffers by computed tomography, plain radiography and Lodox. Eur J
Radiol. 2012;81:251826.
19. Flach PM, Ross SG, Ebert LC, Thali MJ, Ampanozi G. Response to The
detection of internal cocaine drug packs: A radiological challenge in the
future?. Eur J Radiol. 2013;82:158890.
20. Pont J, Stöver H, Wolff H. Dual Loyalty in Prison Health Care. Am J Public
Health. 2012;102:47580.
We accept pre-submission inquiries
Our selector tool helps you to find the most relevant journal
We provide round the clock customer support
Convenient online submission
Thorough peer review
Inclusion in PubMed and all major indexing services
Maximum visibility for your research
Submit your manuscript at
www.biomedcentral.com/submit
Submit your next manuscript to BioMed Central
and we will help you at every step:
Jalbert et al. Journal of Medical Case Reports (2018) 12:35 Page 5 of 5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
... 3,6,7 However, a case study reports pitfall due to a foreign body of similar density mimicking the image of the drug packet located in the stomach. 8 Our case also suggested the drug to be cocaine initially as per the density of the image, later revealed as heroin following numerous tests by the investigation bureau. Urine toxicology has also been used in a few cases for initial evaluation, but not recommended for routine use due to poor of sensitivity of this test. ...
Article
Full-text available
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.
Article
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.
Article
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.
Article
Full-text available
Background: Intrabody concealment of illicit substances is a common practice in the trafficking chain. Bodystuffing, which consists of precipitously swallowing packets of substances for concealment from law-enforcement officers in anticipation of impending search or arrest, is particularly dangerous. There is a risk of rupture 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 bodystuffing. Although the patient denied the facts, the initial reading of the computed tomography (CT) scan confirmed the presence of multiple images compatible with drug packets, which were mostly in the stomach. Upon admission to our secured inpatient ward for clinical surveillance of packet evacuation, the patient denied again having ingested such packets, 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 bodystuffing false positive due to fufu. It illustrates the importance of a history of food intake that could bias the interpretation of CT scan images.
Article
Full-text available
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners.
Article
Full-text available
Management of patients carrying packets of drugs in the digestive tract is a frequent medical problem. We report on a patient who was referred by the police after ingestion of packets of cocaine. After spontaneous elimination of 81 drug packets, the patient had three unremarkable stools. A plain abdominal X-ray disclosed no residual packet but computed tomography (CT) scan showed one in the stomach. As this was not eliminated during the 10 d following ingestion, it was removed through gastrotomy. This case stresses the usefulness of the CT scan to ensure that no residual packet is present before hospital discharge.
Article
Background and study aims: Body packing/stuffing is currently a huge medical problem. A conservative approach and waiting for spontaneous packet expulsion are usually recommended. However, in a patient with packets stuck in the stomach, surgical treatments are generally advocated if complications occur. Endoscopic evacuation of the packets is generally not favored because of its potential hazards, including manipulation and rupture of the packets and deterioration of the patients' condition. However, it may prevent more invasive treatment modalities including surgical intervention. We present case reports on four symptomatic body stuffers with potentially dangerous ingestions who underwent endoscopic evacuation of their packets and survived.
Article
Toxicity due to body packing/pushing/stuffing is a major concern in many countries. Of different imaging techniques, computed tomography (CT) scan is described as the method of choice in detecting body couriers, but there is no study to concomitantly compare with- and without-contrast abdominopelvic CTs to determine the more accurate one for this purpose. We aimed to evaluate the efficacy of abdominopelvic CT "with" and "without" oral contrast in diagnosis of existence, number, and type of packets in body packers/pushers and stuffers. In a prospective observational case series, all suspected cases of body packing/stuffing were included and underwent abdominopelvic CT with and without oral contrast in a one-year period. CT scans were reported by three independent attending radiologists blind to the demographic and clinical results and compared to our defined "gold standard" which was surgery or expulsion of packets. The existence and number of packets detected by each method were compared to define the better method of diagnosis. Of 11 suspect body packers/pushers, 10 carried packs. Abdominopelvic CT with and without oral contrast detected six and seven of them, respectively. In 24 body stuffers, CT without oral contrast was more accurate in diagnosis of existence (9/24 vs. 7/24, p = 0.003) and number (sensitivity and positive predictive values of 29.2% vs. 37.5% and 100% vs. 100% for CTs with and without oral contrast, respectively, p = 0.021). There is a remarkable gap between detection of existence and number of packets/baggies reported by the radiologists and the real condition of the patients. A close teamwork between radiologists and toxicologists is needed to manage these problematic cases.
Article
The aim of this study was to establish a management protocol for body stuffers presenting to the emergency department. This is a retrospective observational case series of patients presenting to the emergency department of a large inner-city hospital as 'body stuffers' during the period between 1 January 2006 and 31 October 2011, irrespective of the type of drug ingested. We reviewed demographic data, ingestion characteristics, clinical progress and outcome. A total of 126 patients were included in the study, with a mean age of 31±8.10 years (range 15-58 years), among whom 106 were male (84%). Drugs ingested were as follows: heroin (n=61, 48%), cocaine (n=58, 46%), other drugs (n=20, 16%) and unknown (n=10, 8%). Of the patients, 23 (18%) ingested more than one drug. At presentation, 96 had features of drug toxicity. The presence of depressant drug toxidrome was more commonly observed among heroin users, but stimulant drug toxidromes were seen across all groups. Of the patients, 12 developed changes in clinical state, with a mean time to development of symptoms of 2 h 50 min±1 h 39 min (range from 1 h 0 min to 5 h 36 min). Abdominal radiography showed the presence of foreign bodies in 8% of the tests performed, and packets were recovered from one patient who underwent gut decontamination. Patients developed new or worsening features of drug toxicity within 6 h of presentation. Toxidromes observed are often not drug/class specific, and treatment including gut decontamination and radiography do not aid in expediting discharge. We propose an observation period of 6 h from the time of admission as the time required if the patient is asymptomatic or there is resolution of presenting signs and symptoms.
Article
Body packing, pushing and stuffing are methods by which illicit drugs may be carried within the human body. Patients involved in these practices may present UK emergency departments with complex medical, legal and ethical considerations. This review article examines not only the evidence behind the clinical management of these patients, but also the legal powers afforded to the authorities to authorise the use of intimate searches and diagnostic imaging for forensic purposes. Serious complications from concealed drug packets are now rare, and most asymptomatic patients may be safely discharged from hospital after assessment. Emergency surgery is indicated for body packers with cocaine poisoning and for some cases of heroin poisoning. Urgent surgery is indicated for obstruction, perforation, the passage of packet fragments and failure of conservative treatment. Guidance is given for doctors who are faced with requests from the authorities to perform intimate searches and diagnostic imaging for forensic purposes.
Article
The purpose of our study was to retrospectively evaluate the specificity, sensitivity and accuracy of computed tomography (CT), digital radiography (DR) and low-dose linear slit digital radiography (LSDR, Lodox(®)) in the detection of internal cocaine containers. Institutional review board approval was obtained. The study collectively consisted of 83 patients (76 males, 7 females, 16-45 years) suspected of having incorporated cocaine drug containers. All underwent radiological imaging; a total of 135 exams were performed: nCT=35, nDR=70, nLSDR=30. An overall calculation of all "drug mules" and a specific evaluation of body packers, pushers and stuffers were performed. The gold standard was stool examination in a dedicated holding cell equipped with a drug toilet. There were 54 drug mules identified in this study. CT of all drug carriers showed the highest diagnostic accuracy 97.1%, sensitivity 100% and specificity 94.1%. DR in all cases was 71.4% accurate, 58.3% sensitive and 85.3% specific. LSDR of all patients with internal cocaine was 60% accurate, 57.9% sensitive and 63.4% specific. CT was the most accurate test studied. Therefore, the detection of internal cocaine drug packs should be performed by CT, rather than by conventional X-ray, in order to apply the most sensitive exam in the medico-legal investigation of suspected drug carriers. Nevertheless, the higher radiation applied by CT than by DR or LSDR needs to be considered. Future studies should include evaluation of low dose CT protocols in order to address germane issues and to reduce dosage.