Death by ‘ice’: fatal methamphetamine intoxication of a body packer case detected by postmortem computed tomography (PMCT) and validated by autopsy

  • Saiful Nizam Bin Abdul Rashid
  • Amir Saad Abdul Rahim
  • Michael J. Thali
  • Patricia M. Flach
Case Report
First Online:
Accepted:

Abstract

Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA ‘body packer’ who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication.

Keywords

Postmortem CT Autopsy Methamphetamine intoxication Drug packing 
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Notes

Acknowledgments

We would like to acknowledge the dedication and skill of the radiographers and mortuary technicians at our institute, who performed the scanning procedure and assisted in the autopsy, respectively.

Conflict of interest

None.

References

  1. 1.
    Li RB, Guan DW, Zhu BL, Zhang GH, Zhao R. Death from accidental poisoning of methamphetamine by leaking into alimentary tract in drug traffic: a case report. Leg Med. 2009;11:491–3.CrossRefGoogle Scholar
  2. 2.
    Takekawa K, Ohmori T, Kido A, Oya M. Methamphetamine body packer: acute poisoning death due to massive leaking of methamphetamine. J Forensic Sci. 2007;52(5):1219–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Shiotani S, Kohno M, Yamazaki K, Nakayama H, Watanabe K, Oyake Y, Itai Y. Non-traumatic postmortem computed tomographic (PMCT) findings of the lung. Forensic Sci Int. 2004;139(1):39–48.PubMedCrossRefGoogle Scholar
  4. 4.
    Flach PM, Ross SG, Thali MJ. Forensic and clinical usage of X-rays in body packing. In: Thali MJ, Viner MD, Brogdon BG, editors. Brogdon’s forensic radiology, 2nd ed. Washington D.C.: CRC Press, Taylor & Francis Group; 2010. pp. 311–334.Google Scholar
  5. 5.
    Bulstrode N, Banks F, Shrotria S. The outcome of drug smuggling by ‘body packers’-the British experience. Ann R Coll Surg Engl. 2002;84(1):35–8.PubMedGoogle Scholar
  6. 6.
    Gomez Antunez M, Cuenca Carvajal C, Farfan Sedano A, Villalba MV, del Toro Cervera J, Garcia Castano J. Complications of intestinal transporting of cocaine packets. Study of 215 cases. Med Clin (Barc). 1998;111:336–7.Google Scholar
  7. 7.
    Joynt BP, Mikhael NZ. Sudden death of a heroin body packer. J Anal Toxicol. 1985;9:238–40.PubMedGoogle Scholar
  8. 8.
    McCarron MM, Wood JD. The cocaine ‘body-packer syndrome: diagnosis and treatment. JAMA. 1983;250:1417–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Beerman R, Nunez D Jr, Wetli CV. Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol. 1986;11:351–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Hergan K, Kofler K, Oser W. Drug smuggling by body packing: what radiologists should know about it. Eur Radiol. 2004;14(4):736–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Niewiarowski S, Gogbashian A, Afaq A, Kantor R, Win Z. Abdominal X-ray signs of intra-intestinal drug smuggling: original research article. J Forensic Leg Med. 2010;17(4):198–202.PubMedCrossRefGoogle Scholar
  12. 12.
    O’Donnell C, Woodford N. Post-mortem radiology-a new sub-speciality? Clin Radiol. 2008;63(11):1189–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Sengupta A, Page P. Window manipulation in diagnosis of body packing using computed tomography. Emerg Radiol. 2008;15(3):203–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Gluecker T, Capasso P, Schnyder P, Gudinchet F, Schaller MD, Revelly JP, Chiolero R, Vock P, Wicky S. Clinical and radiologic features of pulmonary edema. RadioGraphics. 1999;19:1507–31.PubMedGoogle Scholar
  15. 15.
    Shiotani S, Kobayashi T, Hayakawa H, Kikuchi K, Kohno M. Postmortem pulmonary edema: a comparison between immediate and delayed postmortem computed tomography. Leg Med (Tokyo). 2011;13(3):151–5.CrossRefGoogle Scholar
  16. 16.
    Hahn IH, Hoffman RS, Nelson LS. Contrast CT scan fails to detect the last heroin packet. J Emerg Med. 2004;27(3):279–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Musshoff F. Illegal or legitimate use? Precursor compounds to amphetamine and methamphetamine. Drug Metab Rev. 2000;32(1):15–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Nagata. T. Significance of methamphetamine levels in blood and tissues. In: Abstracts of the 67th conference of the medico-legal society of Japan. Osaka: Osaka University; 1983. pp. 11–2.Google Scholar
  19. 19.
    Winek CL, Wahba WW, Winek CL Jr, Balzer TW. Drug and chemical blood-level data. Forensic Sci Int. 2001;122(2–3):107–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Saiful Nizam Bin Abdul Rashid
    • 1
    • 2
  • Amir Saad Abdul Rahim
    • 2
  • Michael J. Thali
    • 3
  • Patricia M. Flach
    • 3
    • 4
  1. 1.Department of Radiology, Faculty of Medicine & Health SciencesUniversity Putra MalaysiaSerdang, Selangor Darul EhsanMalaysia
  2. 2.Department of Forensic Medicine, National Institute of Forensic MedicineHospital Kuala LumpurKuala LumpurMalaysia
  3. 3.Center of Forensic Imaging, Institute of Forensic MedicineUniversity of ZurichZurichSwitzerland
  4. 4.Department of RadiologyUniversity Hospital of ZurichZurichSwitzerland

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