International Journal of Colorectal Disease

, Volume 22, Issue 12, pp 1531–1535 | Cite as

Surgical treatment in cocaine body packers and body pushers

  • Andreas Schaper
  • Rainer Hofmann
  • Philippe Bargain
  • Herbert Desel
  • Martin Ebbecke
  • Claus Langer
Original Article



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.


Cocaine body packers Cocaine body pushers Surgical treatment 


  1. 1.
    Fishbain DA, Wetli CV (1981) Cocaine intoxication, delirium, and death in a body packer. Ann Emerg Med 10:531–532CrossRefPubMedGoogle Scholar
  2. 2.
    Wetli CV, Mittlemann RE (1981) The “body packer syndrome”—toxicity following ingestion of illicit drugs packaged for transportation. J Forensic Sci 26:492–500PubMedGoogle Scholar
  3. 3.
    McCarron MM, Wood JD (1983) The cocaine ‘body packer’ syndrome. Diagnosis and treatment. JAMA 250:1417–1420CrossRefPubMedGoogle Scholar
  4. 4.
    Haugen OA, Dalaker M, Svindland A (1994) Smuggling of narcotics in body cavities. Tidsskr Nor Laegeforen 10:2501–2502Google Scholar
  5. 5.
    Gill JR, Graham SM (2002) Ten years of “body packers” in New York City: 50 deaths. J Forensic Sci 47(4):843–846CrossRefPubMedGoogle Scholar
  6. 6.
    MAHSAN Diagnostika (2005) MAHSAN catalogue for quick tests, p 42Google Scholar
  7. 7.
    Beermann R, Nunez D Jr, Wetli CV (1986) Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol 11:351–354CrossRefGoogle Scholar
  8. 8.
    Hartoko DJ, Demey HE, De Schepper AM, Beaucourt LE, Bossaert LL (1988) The body packer syndrome—cocaine smuggling in the gastro-intestinal tract. Klin Wochenschr 66:1116–1120CrossRefPubMedGoogle Scholar
  9. 9.
    Marc B, Baud FJ, Aelion MJ, Gherardi R et al (1990) The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci 35:345–355CrossRefPubMedGoogle Scholar
  10. 10.
    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 11:154–157CrossRefPubMedGoogle Scholar
  11. 11.
    Hierholzer J, Cordes M, Tantow H, Keske U, Maurer J, Felix R (1995) Drug smuggling by ingested cocaine-filled packages: conventional X-ray and ultrasound. Abdom Imaging 20(4):333–338CrossRefPubMedGoogle Scholar
  12. 12.
    Hoffman RS, Smilkstein MJ, Goldfrank LR (1990) Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem. Am J Emerg Med 8:523–527CrossRefPubMedGoogle Scholar
  13. 13.
    Gomez Antunez M, Cuenca Carvajal C, Farfan Sedano A, Villalba MV, del Toro Cervera J, Garcia Castano J (1998) Complications of intestinal transporting of cocaine packets. Study of 215 cases. Med Clin (Barc) 26:336–337Google Scholar
  14. 14.
    John H, Schoenenberger R, Renner N, Ritz R (1992) Cocaine poisoning from transport of the drug in the gastrointestinal tract (the body-packer syndrome). Dtsch Med Wochenschr 117:1952–1955CrossRefPubMedGoogle Scholar
  15. 15.
    John H, Renner N, Schoenenberger R, Harder F (1994) Intestinal drug transport: a surgical problem? Helv Chir Acta 60:935–938PubMedGoogle Scholar
  16. 16.
    Aldrighetti L, Paganelli M, Giacomelli M, Villa G, Ferla G (1996) Conservative management of cocaine-packet ingestion: experience in Milan, the main Italian smuggling center of South American cocaine. Panminerva Med 38(2):111–116PubMedGoogle Scholar
  17. 17.
    Schaper A, Hofmann R, Ebbecke M, Desel H, Langer C (2003) Cocaine-body-packing. Infrequent indication for laparotomy. Chirurg 74(7):626–631CrossRefPubMedGoogle Scholar
  18. 18.
    Aldrighetti L, Graci C, Paganelli M, Vercesi M et al (1993) Intestinal occlusion in cocaine-packet ingestion. Minerva Chir 48:1233–1237PubMedGoogle Scholar
  19. 19.
    Traub SJ, Hoffman RS, Nelson LS (2003) Body packing—the internal concealment of illicit drugs. N Engl J Med 349(26):2519–2526CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andreas Schaper
    • 1
  • Rainer Hofmann
    • 2
  • Philippe Bargain
    • 3
  • Herbert Desel
    • 1
  • Martin Ebbecke
    • 1
  • Claus Langer
    • 4
  1. 1.GIZ-Nord Poisons Centre, (Giftinformationszentrum-Nord der Länder Bremen, Hamburg, Niedersachsen und Schleswig-Holstein), Zentrum Pharmakologie und ToxikologieGeorg August University, University HospitalGöttingenGermany
  2. 2.Airport Clinic Frankfurt/Main International AirportFrankfurtGermany
  3. 3.Aéroport Charles de GaulleParisFrance
  4. 4.Department of General SurgeryUniversity HospitalGoettingenGermany

Personalised recommendations