Abstract
Body packing is the ingestion or insertion in the human body of packed illicit substances. Over the last 20 years, drug smuggling has increased global and new means of transport of narcotics have emerged. Among these, the most frequent one is the gastrointestinal tract: from mouth to anus, vagina, and ears. Cocaine is one of the most traded drugs, followed by heroin. Condoms, latex gloves, and balloons are typically used as drug packets for retention in the body. There are different radiologic modalities to detect illicit drugs in body packing: Plain radiography, computed tomography (CT), ultrasound, and magnetic resonance. Current protocols recommend the use of radiography to confirm packet retention and, in case of doubt, the use of abdominal CT scan with reduced mAs. In case of packet rupture, catastrophic effects can occur. Management of patients carrying packets of drugs is a recurrent medico-legal problem. To improve diagnostic accuracy and prevent hazardous complications, radiologists and emergency physicians should be familiar with radiologic features of body packing. The radiologist plays both a social and a medico-legal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location. In this review, we focus on diagnostic errors and medico-legal issues related to the radiological assessment of body packers.
Similar content being viewed by others
References
Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M (2015) Body packing: a review of general background, clinical and imaging aspects. Radiol Med 120(1):118–132. doi:10.1007/s11547-014-0458-0
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
UNODC (2013) World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6)
UNDOC (2011) Estimating illicit financial flows resulting from drug trafficking and other transnational organized crimes. Research report. https://www.unodc.org/documents/data-and-analysis/Studies/Illicit_financial_flows_2011_web.pdf
Shahnazi M, Sanei Taheri M, Pourghorban R (2011) Body packing and its radiologic manifestations: a review article. Iran J Radiol 8(4):205–210. doi:10.5812/iranjradiol.4757
Deitel M, Syed AK (1973) Intestinal obstruction by an unusual foreign body. Can Med Assoc J 109(3):211–212
Claffey M (2002) Stampede of drug mules at Kennedy: after 9/11 lull, heroin & ecstasy busts soar New York Daily News. p. 5.
Kucukmetin NT, Gucyetmez B, Poyraz T, et al. (2014) Foreign material in the gastrointestinal tract: cocaine packets. Case Rep Gastroenterol 8(1):56–60 (eCollection 2014). doi:10.1159/000358555
Alkan N (2004) Body packer syndrome (in Turkish). Bagimlilik Dergisi 5:84–90
Schaper A, Hofmann R, Bargain P, et al. (2007) Surgical treatment in cocaine body packers and body pushers. Int J Colorectal Dis 22:1531–1535
Hoffman RS (2006) Cocaine. In: Flomenbaum N, Goldfrank L, Hoffman RS, Howland MA, Lewin N, Nelson L (eds) Goldfrank’s Toxico-logic emergencies, 8th edn. New york: Mcgraw-Hill Publ.Comp, p 603
Dassel PM, Punjabi E (1979) Ingested marihuana-filled balloons. Gastroenterology 76(1):166–169
Utecht MJ, Stone AF, McCarron MM (1993) Heroin body packers. J Emerg Med 11(1):33–40
Watson CJ, Thomson HJ, Johnston PS (1991) Body-packing with amphetamines—an indication for surgery. J R Soc Med 84(5):311–312
Chakrabarty A, Hydros S, Puliyel JM (2006) Smuggling contra-band drugs using paediatric “body packers”. Arch Dis Child 91(1):51
Low VHS, Killius JS (2000) Animal, vegetable, or mineral: a collection of abdominal and alimentary foreign bodies. Esophagus 4:6–8
Khan FY (2005) The cocaine ‘body-packer’ syndrome: diagnosis and treatment. Indian J Med Sci 59(10):457–458
Wetli CV, Mittlemann RE (1981) The “body packer syndrome”-toxicity following ingestion of illicit drugs packaged for transportation. J Forensic Sci 26(3):492–500
Schmidt S, Hugli O, Rizzo E, et al. (2008) Detection of ingested cocaine-filled packets—diagnostic value of unenhanced CT. Eur J Radiol 67(1):133–138
Marc B, Baud FJ, Aelion MJ, et al. (1990) The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci 35:345–355
Cranston PE, Pollack CV Jr, Harrison RB (1992) CT of crack cocaine ingestion. J Comput Assist Tomogr 16:560–563
Hierholzer J, Cordes M, Tantow H, et al. (1995) Drug smuggling by ingested cocaine-filled packages: conventional X-ray and ultrasound. Abdom Imaging 20:333–338
Traub SJ, Hoffman RS, Nelson LS (2003) Body packing—the internal concealment of illicit drugs. N Engl J Med 349:2519–2526
Fineschi V, Centini F, Monciotti F, Turillazzi E (2002) The cocaine “body stuffer” syndrome: a fatal case. Forensic Sci Int 126:7–10
June R, Aks SE, Keys N, Wahl M (2000) Medical outcome of cocaine bodystuffers. J Emerg Med 18:221–224
Aks SE, Vander Hoek TL, Hryhorczuk DO, Negrusz A, Tebbett I (1992) Cocaine liberation from body packets in an in vitro model. Ann Emerg Med 21:1321–1325
Arena JM (1979) Posioning: toxicology, symptoms, treatment, 4th edn. Springfield, IL: Charles C Thomas
Beckley I, Ansari NA, Khwaja HA, Mohsen Y (2009) Clinical management of cocaine body packers: the Hillingdon experience. Can J Surg 52:417–421
Yegane RA, Bashashati M, Hajinasrollah E, et al. (2009) Surgical approach to body packing. Dis Colon Rectum 52:97–103
Taheri MS, Hassanian-Moghaddam H, Birang S, et al. (2008) Swallowed opium packets: CT diagnosis. Abdom Imaging 33:262–266
Jones OM, Shorey BA (2002) Body packers: grading of risk as a guide to management and intervention. Ann R Coll Surg Engl 84(2):131–132
Prabhu R, Neeman A, Bier K, Patel N (2008) Radiology of body packers: the detection of internally concealed illegal materials. Appl Radiol 37(5):26
Wong G, Lai K, Chung C (2005) Management of body packers in the emergency department. Hong Kong J Emerg Med 12(2):112–118
Pidoto RR, Agliata AM, Bertolini R, et al. (2002) A new method of packaging cocaine for international traffic and implications or the management of cocaine body packers. J Emerg Med 23:149–153
Kulkarni VM, Gandhi JA, Gupta RA, et al. (2012) Body packer syndrome. J Postgrad Med 58:225–226
Cordero DR, Medina C, Helfgott A (2006) Cocaine body packing in pregnancy. Ann Emerg Med 48:323–325
de Beer SA, Spiessens G, Mol W, Fa-Si-Oen PR (2008) Surgery for body packing in the Caribbean: a retrospective study of 70 patients. World J Surg 32:281–285 ((discussion 286–287))
Silverberg D, Menes T, Kim U (2006) Surgery for ‘body packers’—a 15-year experience. World J Surg 30:541–546
Hergan K, Kofler K, Oser W (2004) Drug smuggling by body packing: what radiologists should know about it. Eur Radiol 14(4):736–742
Traub SJ, Hoffman RS, Nelson LS (2003) Body packing—the internal concealment of illicit drugs. N Engl J Med 349:2519–2526
Pollack CV Jr, Biggers DW, Carlton FB Jr, et al. (1992) Two crack cocaine body stuffers. Ann Emerg Med 21:1370–1380
Meyers MA (1995) The inside dope: cocaine, condoms, and computed tomography. Abdom Imaging 20:339–340
Beauverd Y, Poletti PA, Wolff H, et al. (2011) A body-packer with a cocaine bag stuck in the stomach. World J Radiol 3(6):155–158. doi:10.4329/wjr.v3.i6.155
Eisen GM, Baron TH, Dominitz JA, et al. (2002) Guideline for the management of ingested foreign bodies. Gastrointest Endosc 55:802–806
Grassi R, Faggian A, Somma F, et al. (2015) Application of imaging guidelines in patients with foreign body ingestion or inhalation: literature review. Semin Ultrasound CT MR 1:48–56
Webb WA (1995) Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 41:39–51
Mandava N, Chang RS, Wang JH, et al. (2011) Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules). Emerg Med J 28:98–101
Visser L, Stricker B, Hoogendoorn M, Vinks A (1998) Do not give paraffin to packers. Lancet 352:1352
White N, Taylor K, Lyszkowski A, Tullett J, Morris C (1988) Dangers of lubricants used with condoms. Nature 335:19
Yang RM, LiL Feng J, LaiSS Lin BQ, et al. (2009) Heroin body packing: clearly discerning drug packets using CT. South Med J 102:470–475
Meijer R, Bots ML (2003) Detection of intestinal drug containers by ultrasound scanning: an airport screening tool? Eur Radiol 13:1312–1315
Hierholzer J, Cordes M, Tantow H, et al. (1995) Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound. Abdom Imaging 20:333–338
Wackerle B, Rupp N, von Clarmann M, et al. (1986) Detection of narcotic-containing packages in “body-packers” using imaging procedures. Studies in vitro and in vivo. Rofo 145:274–277
Sanei Taheri M, Noori M, Nahvi V, Moharamzad Y (2010) Features of neurotoxicity on brain CT of acutely intoxicated unconscious patients. Open Neuroimag J 4:157–163
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
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
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. Radiology 265:772–779
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 CT. Radiology 265(3):772–779. doi:10.1148/radiol.1211276712
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 CT. Eur Radiol 23(8):2146–2155. doi:10.1007/s00330-013-2798-x
Beerman R, Nunez D Jr, Wetli CV (1986) Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol 11(4):351–354
McCarron MM, Wood JD (1983) The cocaine ‘body packer’ syndrome. Diagnosis and treatment. JAMA 250(11):1417–1420
Traub SJ, Hoffman RS, Nelson LS (2003) False-positive abdominal radiography in a body packer resulting from intraabdominal calcifications. Am J Emerg Med 21(7):607–608
Romano L, Pinto A (eds) (2012) Errors in radiology. Milan: © Springer-Verlag Italia
Sica G, Guida F, Bocchini G, et al. (2015) Imaging of drug smuggling by body packing. Semin Ultrasound CT MR 36(1):39–47. doi:10.1053/j.sult.2014.10.003
Marc B, Baud FJ, Aelion MJ, et al. (1990) The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci 35(2):345–355
Alzen G, Banning S, Gunther R (1987) Sonographic detectability of narcotic drug containers in the gastrointestinal tract. Experimental research in the dog. Rofo 146(5):544–547
SaneiTaheri M, Moharmzad Y, Nahvi V (2009) Abdominal CT findings of ruptured opium packets in a body packer. Eur J Radiol Extra 70(1):e21–e23
Eng JG, Aks SE, Waldron R, Marcus C, Issleib S (1999) False-negative abdominal CT scan in a cocaine body stuffer. Am J Emerg Med 17(7):702–704
Saneei Taheri M, Hasanian Moghadam H, Shahnazi Makhtoum BSH, Hemadi H (2007) Diagnosis of opium swallowed in body packers with CT scan: determination hounsfield unit of the packets. Sci J Forensic Med 4:216–221
Wackerle B, Rupp N, Clarmann M, et al. (1986) Demonstration of narcotic packages in “body packers” by various imaging methods. In vitro and in vivo investigations. Fortschr Roentgenstr 145:274–277
Cengel F, Bulakci M, Selcuk T, et al. (2015) The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study. Abdom Imaging. doi:10.1007/s00261-015-0430-z
Hahn IH, Hoffman RS, Nelson LS (2004) Contrast CT scan fails to detect the last heroin packet. J Emerg Med 27(3):279–283
Gherardi R, Marc B, Alberti X, Baud F, Diamant-Berger O (1990) A cocaine body packer with normal abdominal plain radiograms: value of drug detection in urine and contrast study of the bowel. Am J Forensic Med Pathol 11(2):154–157
Gherardi RK, Baud FJ, Leporc P, et al. (1988) Detection of drugs in the urine of body-packers. Lancet 1(8594):1076–1078
Algra PR, Brogdon BG, Marugg RC (2007) Role of radiology in a national initiative to interdict drug smuggling: the Dutch experience. AJR Am J Roentgenol 189(2):331–336
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
Algra PR, Brogdon BG, Marugg RC (2007) Role of radiology in a national initiative to interdict drug smuggling: the Dutch experience. AJR Am J Roentgenol 189(2):331–336
Acknowledgments
The authors acknowledge Mrs. Helis Reiman for her language support and help.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reginelli, A., Russo, A., Urraro, F. et al. Imaging of body packing: errors and medico-legal issues. Abdom Imaging 40, 2127–2142 (2015). https://doi.org/10.1007/s00261-015-0469-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-015-0469-x