La radiologia medica

, Volume 120, Issue 1, pp 118–132 | Cite as

Body packing: a review of general background, clinical and imaging aspects

  • Ferco H. BergerEmail author
  • Koenraad H. Nieboer
  • Gerard S. Goh
  • Antonio Pinto
  • Mariano Scaglione


To avoid detection at border crossings or airport customs, drug trafficking is increasingly performed by intra-corporeal concealment. Body packers may ingest packets of varying size and containing varying drugs (mostly cocaine, heroin and cannabis) mixed with other compounds, while body pushers will insert packets in the rectum or vaginal cavity. Body packing may lead to potential life-threatening complications with acute overdose syndromes after packet rupture and intestinal obstruction with possible ensuing bowel rupture being the most significant complications. Physicians including radiologists should be aware of the capabilities of imaging techniques to screen for presence of drug packets as well as the potential complications. Although conventional radiography has long been and still is the most important imaging modality for screening for presence of intestinal packets, the better test characteristics in conjunction with the decreasing radiation exposure, will likely render computed tomography (CT) more important in the future. For imaging of symptomatic patients, CT already is the modality of choice. Besides these modalities, ultrasound and magnetic resonance imaging will be discussed in this paper, together with more general background and clinical information.


Computed tomography Body packing Body pusher Drug smuggling MRI Cocaine Heroin Abdominal X-ray Emergency 


Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Thomas KV, Bijlsma L, Castiglioni S et al (2012) Comparing illicit drug use in 19 European cities through sewage analysis. Sci Total Environ 432:432–439. doi: 10.1016/j.scitotenv.2012.06.069 PubMedCrossRefGoogle Scholar
  2. 2.
    UNODC (2013) World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6)Google Scholar
  3. 3.
    UNDOC (2011) Estimating illicit financial flows resulting from drug trafficking and other transnational organized crimes. Research report.
  4. 4.
    Bulakci M, Kalelioglu T, Bulakci BB, Kiris A (2013) Comparison of diagnostic value of multidetector computed tomography and X-ray in the detection of body packing. Eur J Radiol 82:1248–1254. doi: 10.1016/j.ejrad.2012.12.022 PubMedCrossRefGoogle Scholar
  5. 5.
    Traub SJ, Hoffman RS, Nelson LS (2003) Body packing—the internal concealment of illicit drugs. N Engl J Med 349(26):2519–2526. doi: 10.1056/NEJMra022719 PubMedCrossRefGoogle Scholar
  6. 6.
    Deitel M, Syed AK (1973) Intestinal obstruction by an unusual foreign body. Can Med Assoc J 109(3):211–212PubMedCentralPubMedGoogle Scholar
  7. 7.
    de Bakker JK, Nanayakkara PWB, Geeraedts LMG et al (2012) Body packers: a plea for conservative treatment. Langenbecks Arch Surg 397(1):125–130. doi: 10.1007/s00423-011-0846-z PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Pinto A, Reginelli A, Pinto F et al (2014) Radiological and practical aspects of body packing. Br J Radiol 87(1036):20130500. doi: 10.1259/bjr.20130500 PubMedCrossRefGoogle Scholar
  9. 9.
    Pidoto RR, Agliata AM, Bertolini R et al (2002) A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers. J Emerg Med 23:149–153PubMedCrossRefGoogle Scholar
  10. 10.
    Dorn T, Ceelen M, de Keijzer KJC et al (2013) Prevalence and medical risks of body packing in the Amsterdam area. J Forensic Leg Med 20(2):86–90. doi: 10.1016/j.jflm.2012.04.025 PubMedCrossRefGoogle Scholar
  11. 11.
    Poletti PA, Canel L, Becker CD et al (2012) Screening of illegal intracorporeal containers (“body packing”): is abdominal radiography sufficiently accurate? A comparative study with low-dose CT. Radiology 265(3):772–779. doi: 10.1148/radiol.12112767 PubMedCrossRefGoogle Scholar
  12. 12.
    Rousset P, Chaillot P, Audureau E et al (2013) Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography—a prospective study. Eur Radiol 23(8):2146–2155. doi: 10.1007/s00330-013-2798-x PubMedCrossRefGoogle Scholar
  13. 13.
    Lee K, Koehn M, Rastegar RF et al (2012) Body packers: the ins and outs of imaging. Can Assoc Radiol J 63(4):318–322. doi: 10.1016/j.carj.2011.06.007 PubMedCrossRefGoogle Scholar
  14. 14.
    Hergan K, Kofler K, Oser W (2004) Drug smuggling by body packing: what radiologists should know about it. Eur Radiol 14(4):736–742. doi: 10.1007/s00330-003-2091-5 PubMedCrossRefGoogle Scholar
  15. 15.
    Asha AE, Higham M, Child P (2014) Sensitivity and specificity of CT scanning for determining the number of internally concealed packages in ‘body-packers’. Emerg Med J. doi: 10.1136/emermed-2013-203389 Google Scholar
  16. 16.
    Sormaala MJ, Salonen H, Mattila VM et al (2012) Feasibility of abdominal plain film images in evaluation suspected drug smuggler. Eur J Radiol 81(9):2118–2121. doi: 10.1016/j.ejrad.2011.08.016 PubMedCrossRefGoogle Scholar
  17. 17.
    Niewiarowski S, Gogbashian A, Afaq A et al (2010) Abdominal X-ray signs of intra-intestinal drug smuggling. J Forensic Leg Med 17(4):198–202. doi: 10.1016/j.jflm.2009.12.013 PubMedCrossRefGoogle Scholar
  18. 18.
    Burillo-Putze G, Becker LT, Rodriquez MG et al (2012) Liquid cocaine body packers. Clin Toxicol (Phila) 50(6):522–524. doi: 10.3109/15563650.2012.687742 CrossRefGoogle Scholar
  19. 19.
    Flach PM, Ross SG, Ampanozi G et al (2012) “Drug mules” as 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 81(10):2518–2526. doi: 10.1016/j.ejrad.2011.11.025 PubMedCrossRefGoogle Scholar
  20. 20.
    Schmidt S, Hugli O, Rizzo E et al (2008) Detection of ingested cocaine-filled packets—diagnostic value of unenhanced CT. Eur J Radiol 67:133–138. doi: 10.1016/j.ejrad.2007.07.017 PubMedCrossRefGoogle Scholar
  21. 21.
    Taheri MS, Hassanian-Moghaddam H, Birang S et al (2008) Swallowed opium packets: CT diagnosis. Abdom Imaging 33(3):262–266. doi: 10.1007/s00261-007-9269-2 PubMedCrossRefGoogle Scholar
  22. 22.
    Yang R, Li L, Feng J et al (2009) Heroin body packing: clearly discerning drug packets using CT. South Med J 102(5):470–475. doi: 10.1097/SMJ.0b013e31819ecacc PubMedCrossRefGoogle Scholar
  23. 23.
    Hahn IH, Hoffman RS, Nelson LS (2004) Contrast CT scans fails to detect the last heroin packet. J Emerg Med 27(3):279–283. doi: 10.1016/j.jemermed.2004.04.012 PubMedCrossRefGoogle Scholar
  24. 24.
    Eng JG, Aks SE, Waldron R et al (1999) False-negative abdominal CT scan in a cocaine body stuffer. Am J Emerg Med 17(7):702–704PubMedCrossRefGoogle Scholar
  25. 25.
    Sengupta A, Page P (2008) Window manipulation in diagnosis of body packing using computed tomography. Emerg Radiol 15:203–205. doi: 10.1007/s10140-007-0652-7 PubMedCrossRefGoogle Scholar
  26. 26.
    Wackerle B, Rupp N, von Clarmann M et al (1986) Demonstration of narcotic packages in “body packers” by varying imaging methods. In vitro and in vivo investigations. Fortschr Roentgenstr 145:274–277CrossRefGoogle Scholar
  27. 27.
    Leschka S, Fornaro J, Laberke P et al (2013) Differentiation of cocaine from heroin body packs by computed tomography: impact of different tube voltages and the dual-energy index. J Forensic Radiol Imaging 1:46–50CrossRefGoogle Scholar
  28. 28.
    Médiouni Z, Steffen M, Becour B (2013) Incidentalomas revealed by abdominopelvic computed tomography scans performed in body packers. Am J Forensic Med Pathol 34(4):331–334. doi: 10.1097/PAF.0b013e31829f6901 PubMedCrossRefGoogle Scholar
  29. 29.
    Meijer R, Bots ML (2003) Detection of intestinal drug containers by ultrasound scanning: an airport screening tool? Eur Radiol 13(6):1312–1315. doi: 10.1007/s00330-002-1689-3 PubMedGoogle Scholar
  30. 30.
    Bulakci M, Ozbakir B, Kiris A (2013) Detection of body packing by magnetic resonance imaging: a new diagnostic tool? Abdom Imaging 38:436–441. doi: 10.1007/s00261-012-9972-5 PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2014

Authors and Affiliations

  • Ferco H. Berger
    • 1
    Email author
  • Koenraad H. Nieboer
    • 2
  • Gerard S. Goh
    • 3
  • Antonio Pinto
    • 4
  • Mariano Scaglione
    • 5
  1. 1.Department of Radiology and Nuclear MedicineVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Radiology, UZ BrusselVrije Universiteit BrusselBrusselsBelgium
  3. 3.Department of RadiologyThe AlfredMelbourneAustralia
  4. 4.Department of RadiologyCardarelli HospitalNaplesItaly
  5. 5.Department of Diagnostic ImagingPineta Grande Medical CenterCasertaItaly

Personalised recommendations