Body Packing: A Case of Intestinal Heroin Transport

Abstract

A 50-year-old woman ingested 50 pellets of packed heroin for transport. Detained by customs agents in an international airport because of a history of drug trafficking, the patient was brought to the emergency department by law enforcement. Her medical history included a general anxiety disorder treated with diazepam. On physical examination, the patient was alert, coherent, and normotensive, with a normal respiratory rate. Findings on pupillary and abdominal examination were normal. A complete blood cell count and metabolic panel were within normal limits. A urinary toxicology examination was positive for benzodiazepines. Upright abdominal radiography revealed rectangular intracolonic masses. Abdominal computed tomography without contrast revealed numerous pellets in the ascending and transverse colon, with no obstruction or inflammation. The patient was given an electrolyte lavage solution. She showed no signs of sedation, dyspnea, peritonitis, or obstruction. Customs agents collected 49 intact pellets that each contained 12 g of heroin. Repeated imaging confirmed decontamination. On discharge, the patient was taken into federal custody. Body packing is the ingestion or insertion of packed illicit substance for transport. Imaging is essential in diagnosing body packing. Although abdominal radiography and ultrasonography are useful screening tools in airports,1 computed tomography is more effective in the assessment and management of patients.2 Body packers should undergo whole-bowel irrigation to hasten transit time. Heroin packers should receive naloxone hydrochloride if they are sedated or are experiencing respiratory depression. In cases of severe opiate toxicity, patients are at increased risk of acute lung injury, and surgical decontamination should be considered.3