Abstract
Objective
To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT).
Methods
Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination.
Results
Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4–58.1) and 100.0 % (95 % CI: 97.0–100.0) for reader 1 and 35.7 % (95 % CI: 12.8–64.9) and 97.6 % (95 % CI: 93.1–99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance.
Conclusion
Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers.
Key Points
• Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets.
• Ten per cent of body packers had residual packets despite two packet-free stools.
• Seventy per cent of these residual packets were missed on AXR.
• No patient or packet characteristics predicted residual packets or AXR false negativity.
• CT is necessary to ensure safe medical discharge of body packers.
Similar content being viewed by others
Abbreviations
- AXR:
-
Abdominal X-ray (radiography)
- CT:
-
Computed tomography
References
United Nations Office on Drugs and Crime. Drug trafficking. Available via http://www.unodc.org/unodc/en/drug-trafficking/index.html. Accessed Novembre 22, 2012
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
Traub SJ, Hoffman RS, Nelson LS (2003) Body packing–the internal concealment of illicit drugs. N Engl J Med 349:2519–2526
Gherardi RK, Baud FJ, Leporc P, Marc B, Dupeyron JP, Diamant-Berger O (1988) Detection of drugs in the urine of body-packers. Lancet 1:1076–1078
Goertemoeller S, Behrman A (2006) The risky business of body packers and body stuffers. J Emerg Nurs 32:541–544
de Prost N, Lefebvre A, Questel F et al (2005) Prognosis of cocaine body-packers. Intensive Care Med 31:955–958
Pidoto RR, Agliata AM, Bertolini R, Mainini A, Rossi G, Giani G (2002) A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers. J Emerg Med 23:149–153
Veyrie N, Servajean S, Aissat A, Corigliano N, Angelakov C, Bouillot JL (2008) Value of a systematic operative protocol for cocaine body packers. World J Surg 32:1432–1437
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 189:331–336
Hergan K, Kofler K, Oser W (2004) Drug smuggling by body packing: what radiologists should know about it. Eur Radiol 14:736–742
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 265:772–779
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 81:2518–2526
Beauverd Y, Poletti PA, Wolff H, Ris F, Dumonceau JM, Elger BS (2011) A body-packer with a cocaine bag stuck in the stomach. World J Radiol 3:155–158
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
McCarron MM, Wood JD (1983) The cocaine ‘body packer’ syndrome. Diagnosis and treatment. Jama 250:1417–1420
Niewiarowski S, Gogbashian A, Afaq A, Kantor R, Win Z (2010) Abdominal X-ray signs of intra-intestinal drug smuggling. J Forensic Leg Med 17:198–202
Institut de radioprotection et de sureté nucléaire. Niveaux de référence diagnostiques. Tableau 4. Available via http://nrd.irsn.fr/index.php?page=radiologie. Accessed November 22, 2012
The 2007 Recommendations of the International Commission on Radiological Protection (2007) ICRP Publication 103. Ann ICRP 37:1–332
Jones DG, Shrimpton PC (1991) Survey of CT practice. Part 3: normalised organ doses calculated using Monte Carlo techniques. Document NRPB-R250. Chilton, UK: National Radiological Protection Board
Zankl M, Panzer W, Drexler G (1991) The calculation of dose from external photon exposures using reference human phantoms and Monte Carlo methods. Part VI. Organ doses from computed tomographic examinations. GSF-Bericht 30/91. Munich, Germany: GSF
Stamm G, Nagel HD (2002) CT-expo–a novel program for dose evaluation in CT. Rofo 174:1570–1576
Hart D, Jones DG, Wall BF (1994) “Normalised organ doses for medical x-ray examinations calculated using Monte Carlo techniques”, NRPB-SR262 Chilton: NRPB
Bossuyt PM, Reitsma JB, Bruns DE et al (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD Initiative. Ann Intern Med 138:40–44
Bossuyt PM, Reitsma JB, Bruns DE et al (2003) The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 138:1–12
Hunter TB, Taljanovic MS (2003) Foreign bodies. Radiographics 23:731–757
Muhletaler CA, Gerlock AJ Jr, Shull HJ, Adkins RB Jr (1980) The pill bottle desiccant. A cause of partial gastrointestinal obstruction. Jama 243:1921–1922
White paper on radiation protection by the European Society of Radiology (2011). Insights Imaging 2:357–362
Kalra MK, Maher MM, D’Souza RV et al (2005) Detection of urinary tract stones at low-radiation-dose CT with z-axis automatic tube current modulation: phantom and clinical studies. Radiology 235:523–529
Niemann T, Kollmann T, Bongartz G (2008) Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol 191:396–401
Maurer MH, Niehues SM, Schnapauff D et al (2011) Low-dose computed tomography to detect body-packing in an animal model. Eur J Radiol 78:302–306
Author information
Authors and Affiliations
Corresponding author
Additional information
The institution from which this work originated: Hôtel-Dieu University Hospital, 1 place du Parvis Notre Dame, 75004, Paris
Electronic supplementary material
Below is the link to the electronic supplementary material.
Figure 1
Photograph of (a) a hand-made packet and (b) a machine-produced packet. (DOC 3.05 mb)
Rights and permissions
About this article
Cite this article
Rousset, P., Chaillot, PF., Audureau, E. et al. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography—a prospective study. Eur Radiol 23, 2146–2155 (2013). https://doi.org/10.1007/s00330-013-2798-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-013-2798-x