Body packing

Background

Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.

• Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders
• Packets usually made of several layers of latex and outer wax coating
• Each packet contains about 10g of drug and body packers ingest between 50 to 100 drug containers at a time
• Sometimes packets are inserted rectally or vaginally
• Vs body stuffing, ingestion of illicit drugs while pursued by law enforcement; usually small quantity

Clinical Features

• Situations in which body packers present to the ED:
  • Asymptomatic but in custody
  • Signs of Toxidromes from a ruptured packet
  • Signs of bowel obstruction or perforation

Evaluation

• History and physical
  • Type of drug
  • Type of packet wrapping (more likely to rupture or leak of home made)
  • Number of packets ingested
  • GI symptoms (pain, distention, obstipation)
  • Other drug use
• Imaging: KUB, CT abdomen pelvis
• Urine drug screen: may be misleading

Management

• Asymptomatic patients
  • Expectant management, no surgery, close monitoring in ICU until passage of all packets
  • Whole bowel irrigation with polyethylene glycol via NGT at 2L per hour
  • Activated charcoal more useful in body stuffers
• Opioid toxicity
  • Naloxone: may require very high doses
    • 2 to 5mg IV initially, repeat 2mg q5min until responsive
    • then total amount required for response should be given every hour as continuous drip
• Sympathomimetic toxicity
  • Immediate OR for surgical decontamination
  • No place for conservative management
  • Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR
    • Hyperthermia
      • Active external cooling
      • IV benzodiazepines

See Also

Ingested foreign body