Surgical treatment in cocaine body packers and body pushers
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- Schaper, A., Hofmann, R., Bargain, P. et al. Int J Colorectal Dis (2007) 22: 1531. doi:10.1007/s00384-007-0324-9
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Body packers smuggle cocaine by swallowing containers filled with the drugs, whilst body pushers conceal the containers in the rectum or vagina. In a collaborative effort between the Department of General Surgery, two major airports and Poisons Centre, we performed a retrospective study to develop an algorithm for the treatment of ruptured cocaine-filled containers.
Materials and methods
The data of all cocaine body packers and body pushers who were identified at the airports of Frankfurt and Paris from 1985 to 2002 were evaluated concerning incidence, demographics and surgical aspects.
From 1985 to 2002, 312 body pushers and 4,660 body packers were identified. The sex ratio was 1:1. Sixty-four “mules” (1.4%) developed life-threatening symptoms of cocaine overdose after the rupture of a container. In 20 patients, an emergency laparotomy was performed and the containers were removed; all of these patients survived. Forty-four body packers died before surgical treatment could be performed. Only one body pusher required medical attention.
Cocaine overdose can be life-threatening. If the cause is the rupture of a container in a body packer, the only possible treatment is immediate laparotomy for the removal of the container.
KeywordsCocaine body packersCocaine body pushersSurgical treatment
Cocaine is made from the leaves of Erythroxylum coca, a plant that grows only in the South American Andes. Cocaine abuse is a well-known phenomenon in South America, in North America and in Europe. It is smuggled into North America and Europe via several methods using humans as carriers. Body packers or “mules” (the donkey-like animals used for carrying heavy things) smuggle the drug by swallowing cocaine-filled containers, whilst body pushers hide cocaine packages in body cavities such as the rectum or vagina.
In a collaborative effort between the Airport Clinic Frankfurt/Main International Airport in Germany, the Charles de Gaulle International Airport in Paris, France, the Department of General Surgery in Göttingen, Germany and the GIZ-Nord Poisons Centre in Göttingen, Germany, an analysis of the medical and surgical aspects of international drug smuggling was performed. The aim of this study was to develop an algorithm for the evaluation and treatment of suspected cocaine body packers and body pushers. We were particularly interested in the treatment of ruptured containers. Because the situation is totally different concerning heroin with a very efficient and selective antidote, the smuggling of this drug was not the scope of the present study.
Materials and methods
In an 18-year retrospective study, the records of all cocaine body packers and body pushers detained and treated at the Frankfurt and Paris airports were analysed. In particular, we examined the demographic data, incidence, treatment and outcomes of body packers and body pushers.
The phenomenon of drug smuggling by body packing or body pushing has been a common practice for more than 20 years [1–5]. Cocaine body packers are paid approximately 3,000 euros for 1 transport—often swallowing up to 100 containers containing cocaine worth up to 50,000 euros. Although the containers are not usually condoms, as they were in the early days of body pushing and body packing, the industrially produced containers used today can still rupture, causing a life-threatening cocaine overdose [1, 5]. Although the quality of the containers has increased, there has to be no leakage for a positive result of the test: obviously the small amounts of cocaine on the surface of the containers—during the processing—are enough to be detected with the test. Over the 18 years of the study, several tests were applied at the 2 airports. In our experience, all tests had a high sensitivity because all persons with a positive result turned out to be either a drug smuggler or a drug consumer. As an example, the MAHSAN-COC® test can be mentioned: the sensitivity is 96.3%, whereas the specificity is 99.8% .
Each container used for cocaine smuggling contains approximately 10 g of pure cocaine, which is a potentially lethal dose. The clinical symptoms of a severe cocaine overdose affect the cardiovascular, gastrointestinal and central nervous systems. The most frequent symptom is a generalised seizure. Physicians must keep these symptoms in mind as a potential sign of a ruptured container in a body packer because the rupture of a cocaine-filled container is rare, even though body packing is quite common.
In conclusion, cocaine body packing remains an immediate medical and surgical problem. There are still large numbers of body packers, but the rupture of a container is rare. Physicians involved in this field should be well aware that a laparotomy could be lifesaving when rupture of a cocaine-filled container does occur.