1304

Abstract

Introduction: Background and Information "Drug mules" are people who smuggle drugs across a national border. The ones who do so by swallowing wrapped pellets of drugs face a serious health risk, as pellets can leak or burst while still in the body. A plain x-ray is the method of choice for detection of packing in the GI tract because of its low cost. However, other imaging techniques may be warranted, especially when health risk involved. Case Presentation A twenty year-old female was brought to the hospital after flagging down an EMS vehicle, with the complaint of not feeling well after trying cocaine. She then collapsed from a seizure. Urine toxicology confirmed the presence of cocaine in her system. Her persistent tachycardia did not respond to appropriate medical treatment and she then suffered a second seizure and lost pulse. She was intubated; ROSC was achieved after 21 minutes of CPR. For days, patient remained tachycardic and was unable to be weaned off the ventilator. She also became febrile and developed new pleural effusions. Due to suspicion of this patient harboring drugs in her body, an abdominal radiography was performed but was unremarkable. She continued to have normal bowel movements. On the eighth day of admission, three suspicious foreign bodies that appeared to be translucent wrappings that contained a white substance were found in the patient's diaper, one of which was leaking. An abdominal and pelvic CT without contrast was immediately performed, revealing multiple foreign bodies throughout the GI tract. One appeared less dense than the others, raising suspicion of rupture. The patient underwent emergent exploratory laparotomy removal of all foreign bodies. Her conditions improved quickly and she was discharged a few days later. Discussion Our patient presented with a few clues pointing to the possibility that she might have been harboring drugs in her body. However, all doubts were thwarted by negative findings on plain abdominal radiography. In a Swiss study, CT was found to be 100 percent accurate in detecting cocaine containers in a drug mule's body, compared to only 70 percent with digital x-ray. While not surprising, these findings, along with our case, should encourage more CT use when warranted.