Body Packing Research Articles

Cocaine-Filled Capsule Detected after Firearm Injury: A Case Report

Emergency departments are facing increasing drug-related health problems with difficult medicolegal and social consequences. A 25-year-old male with no past medical history arrived at our emergency department. He was brought to the emergency room of our hospital by the security forces, as he suffered a gunshot wound while traveling to a place. The cocaine-filled capsule was seen on plain abdominal film. The plain abdominal film is the most commonly used radiological tool to detect 2-8 cm drug-filled packages within the gastrointestinal tract of body packers. In a study that analyzed the role of drugs in firearm deaths in New York between 1990 and 1998, more than half of firearm deaths had positive drug toxicology. Physicians working in the emergency unit should be prepared for secondary diagnoses. In addition, different examination and imaging findings should be kept in mind in suspicious cases.

A new “Stethoscope” autopsy incision in comparison to various conventional incisions along with suturing techniques and body packing methods for post autopsy reconstruction

Post autopsy reconstruction (PAR) plays a vital role in the external appearance of dead bodies while handing over to grieving family members. Autopsy surgeons should not only be restricted to autopsy findings/techniques but should also give importance to PAR. Autopsy incision includes various conventional incisions like I, Y, and Modified Y-shaped. The most commonly used incision is I -shaped in most of the autopsy because it is easy for quick suturing but it produces a poor cosmetic appearance because suturing produces visible suture over the front of the neck and chest of a corpse and improper suturing in the skin flaps leads to gapping causes leakage of body fluids at the suture site. More often that leads to avoidable, unnecessary emotional distress for grieving family members. That creates a negative image of forensic practice in society and sometimes with administrative complaints. The authors conducted an observation based study on the medicolegal autopsy that included ten cases that involved “Stethoscope” and various conventional incisions and explored suturing techniques and body packing methods. The study observed that the proposed “Stethoscope” incision was feasible, less time-consuming for suturing, had an excellent cosmetic effect, and was cost-effective. The suturing technique revealed that invisible sutures leads to good cosmetic outcomes but is more time-consuming and costly. The body packing method showed the excellent result of no leakage of body fluid from the suture site. The authors proposed a “Stethoscope” method of incision that can be practiced and adopted for a better cosmetic appearance and humanitarian aspect for grieving relatives. The body packing method renders the body non-hazardous to the public and attendants while handling and transporting. The authors highlight the importance and sensitization of autopsy surgeon/mortuary staff to restructure the corpse with the best cosmetic appearance for the Dignified Management of the Dead and Humanitarian Forensics.

An updated review on anesthesia and emergency medicine for forensic medicine practice

‘Anesthesia’ and ‘Emergency Medicine’ for ‘Forensic Medicine’ practice is an infrequently discussed topic in the current English literature. Demand of anesthesia and emergency medicine for forensic medical cases will probably increase in the future due to the ever-growing rate of drug trafficking and escalated sexual crimes at the regional as well as global levels. To address the relative scarcity of a review on this aspect, a comprehensive literature search was conducted using Cochrane, Medline, Scopus, and Google Scholar databases, to put forward the most up-to-date recommendations and guidance on the topic, which would shed light and help raise awareness among the emergency physicians, anesthetists, and intensivists about this important aspect of medical practice, ultimately improving the medical care of the affected ones without any prejudice and thus improve the outcome.
 Key words: Anesthesia; Body packers; Body stuffers; Emergency Medicine; Forensic Medicine; Sexual abuse
 Citation: Munasinghe BM, Pranavan S, Mayorathan U. An updated review on anesthesia and emergency medicine for forensic medicine practice. Anaesth. pain intensive care 2022;26(6):803−806; DOI: 10.35975/apic.v26i6.2057

Body stuffing during apprehension resulting in distal esophageal impaction: a case report and review of the literature

BackgroundBody stuffing and body packing are two methods of concealing illicit drugs. Body stuffing is defined as the oral ingestion of illicit drugs, typically to avoid law enforcement detection or other consequences of possession, and may present a serious medical emergency in patients. Most commonly, body stuffers ingest possibly large or unknown quantities of illicit substances to avoid detection of the drugs during apprehension. This ingestion is typically hasty or impulsive, and therefore the substances ingested are rarely packaged in a way that would be considered safe for ingestion.Case presentationThis case highlights a series of rare complications of impacted esophageal foreign body including esophageal edema, pericarditis, and hydro-pneumothorax for a 16-year-old Hispanic male who was booked into a county juvenile detention and rehabilitation facility. He complained of persistent intractable epigastric pain, along with pleuritic chest pain with multiple episodes of vomiting over the previous 4 days. He denied swallowing any foreign body. He underwent esophagogastroduodenoscopy, and a plastic bag with content suspicious for marijuana was discovered in the distal esophagus and removed.ConclusionsFailure to consider body stuffing and foreign body impaction in individuals during medical evaluation in detention centers with complaints of chest pain, abdominal pain, dysphagia, and/or certain toxidromes can delay diagnosis and lead to a variety of medical complications.

International Smuggling of Illicit Drugs by Body Concealment at a Tertiary Hospital in Istanbul.

Smuggling of illicit substances by internal concealment has recently become a preferred method of international drug trade. The drug carriers are known as body packers. This study aimed to assess the demographic features and outcomes of body packers admitted to a referral center in Istanbul. Data were retrospectively evaluated from January 2017 to December 2019 from suspected body packers who were referred to the emergency department of a tertiary-care university by Istanbul Airport narcotics police due to suspected concealment of illicit drugs. Eighty-one cases were identified and included in this study. Of these, 71 subjects were confirmed to be body packers by radiological methods. The 15 women and 56 men had a mean age of 35 years. The most common nationality of the body packers was Nigerian, followed by Turkish and South African. Cocaine was the most commonly smuggled packet, followed by hashish, and heroin. All body packers were conservatively managed using laxatives or watchful waiting. No cases required surgical retrieval of packets. Abdominal radiography and computed tomography are useful tools for the evaluation of suspected body packers. The use of improved packaging material by smugglers and complications due to surgery and endoscopy make the conservative approach preferred.

Fatal cocaine poisoning in a body stuffer

To describe a fatal cocaine poisoning in a body stuffer resulting from extremely high plasma concentrations. Body stuffing refers to the swallowing of small amounts of poorly wrapped drug aiming to conceal it. Usually, complications are due to the direct drug toxicity (Roberts et al., Am J Emerg Med 1986:24–27). We report a 34-year-old male who developed seizures after swallowing small drug packs in a parking. Rapidly, he presented a cardiac arrest when the prehospital medical team arrived (no flow, 1 min). During tracheal intubation, a plastic pack containing a white powder was extracted from the patient's mouth. Due to refractory cardiac arrest, venoarterial ECMO was implemented on intensive care unit (ICU) admission. Despite optimal supportive care, multiple organ failure developed, and the patient died 24 h after ICU admission. Four blood and one urine samples were collected between ICU admission and death onset. The small pack containing a white powder was sent to the laboratory. Extensive toxicological screening was performed using immunological and enzymatic methods, LC-DAD/MS, LC-HR/MS and GC-MS. Plasma concentrations of cocaine and its two major metabolites benzoylecgonine and ecgonine methyl ester (EME) were determined using a specific LC-MS/MS assay. Toxicological analysis of the powder was performed using a specific GC-MS method. Cocaine and tetrahydrocannabinol screening was positive in urine. Plasma concentrations of cocaine, benzoylecgonine and EME were 8600, 13,420 and 9540 ng/mL, respectively in the earliest sample collected 2.8 hours post-cardiac arrest onset. In the last sample collected at 21.3 hours post-cardiac arrest, plasma cocaine concentration declined to 1240 ng/mL whereas benzoylecgonine and EME concentrations increased to 32,720 and 12,700 ng/mL, respectively. Cocaine elimination half-life was estimated at 6 h. During the first 4 hours, metabolic ratios were 1.5 (benzoylecgonine/cocaine) and 1 (EME/cocaine) before a marked increase in benzoylecgonine/cocaine and EME/cocaine ratios up to 11–26 and 6–10, respectively. Positive tetrahydrocannabinol was confirmed in LC-HR/MS. No usual adulterant as levamisole or phenacetin compounds was detected in blood and urine. Quantitative analysis GC-MS analysis reported a pure cocaine powder. The acute toxicity including sudden cardiac arrest in this body stuffer appeared in relation to extremely high plasma cocaine concentrations. Such elevated concentrations were rarely observed in body stuffers/packers (Soichot et al., ToxAC 2018;30:229–238) with metabolic ratios of ∼1 in the first hour post-ingestion. Here we described the time-course of plasma concentrations of cocaine and its metabolites during a 21h-period before the patient's death. There was a marked increase in cocaine metabolite concentrations and metabolic ratios, particularly the benzoylecgonine/cocaine ratio. Prolongation to 6 h of cocaine elimination half-life was consistent with the previously reported value of 7.6 h in a body packer (De Prost et al., Hum Exp Toxicol 2010;29:49–53). However, our report presents limitations related to the lack of information regarding cocaine consumption by the patient and the small sample number not allowing performing a toxicokinetic study. By contrast, to body packers, body stuffers mostly carry small cocaine amounts. However, cocaine concentration can be extremely high following the low-quality pack rupture in the stuffer's mouth like in our case. Drug purity found in our analysis supported a street deal with the attempt to conceal the sales product. Nevertheless, body stuffers are often drug users, which could be questioned in our patient, as suggested by the positive tetrahydrocannabinol screening. Our body stuffer developed a fatal cardiac arrest in relation to elevated plasma concentrations of cocaine and its metabolites resulting from a cocaine pack rupture. Toxicokinetic data are still expected to better understand the physiopathology of cocaine toxicity in such cases.

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond.

Introduction: Body packing consists of the concealment of substances (drugs and non-narcotics) or products inside the human body with the purpose of smuggling and may represent an emergency due to the fatal risk of narcotic toxicity, intestinal obstruction, and visceral perforation. However, non-narcotic body packing, especially in developing countries, is under-evaluated. Thus, the objective of this study was to evaluate cases of body packers in Brazil as regards narcotic and non-narcotic contents.Methods: This retrospective study analyzes the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil.Results: Ten cases of body packing were observed. We found that five patients carried drugs, while seven carried non-narcotic substances such as cell phones and accessories. All the patients were male, prisoners, and young adults. In six patients, there was gastrointestinal obstruction, and in three, there was acute narcotic intoxication. Abdominal radiography diagnosed eight of the cases. In nine of the cases, emergency laparotomy was required, but all patients successfully recovered.Conclusion: There was a higher prevalence of body packing of non-narcotic content; however, diagnostic and surgical approaches were similar to those of narcotic content. Clinicians must be aware of both non-narcotic and narcotic body packing.

CASE REPORT ON A NOVEL MANAGEMENT APPROACH FOR A BODY PACKER IN INDIA

Packaging of illicit drugs , concealed within the body by swallowing or insertion into vagina or rectum is called body packing. A 50 year old male patient brought by the customs department with alleged complaints of ingesting 50-60 contraband substance packets 6 days ago ; with no associated vomiting / pain abdomen / fever. General survey including vitals were under normal limits and examination of the abdomen was soft with no palpable mass or tenderness .Preliminary routine blood workup showed no derangements. Imaging studies like CT scan revealed multiple, well dened hyper-dense foreign bodies(drug packets) within small and large bowel loops with no signs of obstruction. A conservative management approach was adopted for this patient with IV uids, antibiotics, analgesics , antiemetics , proton pump inhibitors along with bulk laxatives. Intensive monitoring and frequent physical examination was done. The patient purged out a total of 108 drug packets in 6 days , with an uneventful hospital stay.

Garcin syndrome caused by rhino-orbito-cerebral mucormycosis

Total paralysis of all or near all unilateral cranial nerves indicates Garcin syndrome. Garcin syndrome caused by Rhino-Orbito-Cerebral Mucormycosis (ROCM) complicating with cerebral infarction has been reported rarely. ROCM is an opportunistic fungal infection with high morbidity and mortality rates despite treatment due to acute angioinvasive infections. We report the case of a 69-year-old female, with a history of type 2 Diabetes Mellitus (DM), who presented Garcin syndrome caused by ROCM.

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents.

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents.

« Je suis le fléau du monde » : à propos d’un épisode mélancolique chez un adolescent avec autisme de 17 ans, perspective développementale

Diagnosing depression during adolescence is complex due to the variety of manifestations encountered. Besides, depression is a common comorbidity in autism spectrum disorders and can be difficult to diagnose. We report here the case of a 17-year-old adolescent hospitalized for major hetero-aggressive behavior in a context of melancholic depression. We present the multidisciplinary care provided: psychotherapeutic, medication, family, and body packing. The case of this patient was complex due to multiple “internal” constraints linked to comorbidities (autism spectrum disorder, coordination impairment, attention disorder, sluggish cognitive tempo), as well as “external” constraints (complicated family context, worsening of disorders coinciding with the start of the SARS-cov-19 epidemic and the closure of the day hospital supporting him). These factors raised important questions in the choice of treatments for this patient, required several months of hospitalization and opened a discussion around differential diagnoses.

Management of Patients With Drug Packet Ingestion (Body Packers): A Narrative Review

Context: Due to the increased freight traffic and illicit movement of drug packages disguised inside the body, as well as the shortage of adequate surgical textbook references regarding the management, we aimed to utilize our clinical experience and collect relevant content to present a plausible solution. Evidence Acquisition: The PubMed, Scopus, Web of Sciences, and Google Scholar databases were systematically searched for related articles. Results: Of the overall 294 retrieved articles, 37 articles remained for review after the exclusion of duplicates and unrelated papers. Imaging is beneficial in several cases of body packing. Abdominopelvic computed tomography without contrast, which is likely the best diagnostic tool for identifying the existence and quantity of packets in these patents, can help doctors avoid common diagnostic mistakes. Whether it be opioids, cocaine, or amphetamines, each drug class should have a customized course of action. Conclusion: Although conservative treatment is often employed for these individuals, early surgical intervention for packet removal is advised in the cases of ingesting cocaine and amphetamine packets due to the lack of an appropriate antagonist.

Body Packing: Hiding in Plain Sight.

A 31-year-old man was brought to the emergency department by airport customs officials for medical examination due to suspicion of concealed drugs in his body. He was conscious and oriented with a blood pressure of 124/80 mm Hg and a pulse rate of 80 beats/min. Respiratory and cardiovascular system examinations were normal. Abdomen was soft and nontender, but rectal examination revealed multiple pellet-like structures in the rectum. Blood and urine examinations for toxins were unremarkable.

Physical Examination and Clinical Course of Poisoning and Drug Overdose

Poisoning refers to the development of dose-related adverse effects following exposure to drugs, chemicals, or other xenobiotics. To paraphrase Paracelsus, the dose creates the poison. Although most poisons have predictable dose-related effects, individual responses to a given dose may vary due to inhibition in the presence of other xenobiotics, genetic polymorphism, enzymatic induction, or acquired tolerance. Poisoning may be local (e.g. lungs, skin, eyes) or systemic depending on the route of exposure, the physical and chemical properties of the poison, and its mechanism of action. The reversibility and severity of poisoning also depend on the functional reserve of the target organ or individual which is influenced by preexisting disease and age. The history should include the route, duration, time, and circumstances (surrounding events, location, and intent) of exposure; the amount and name of each chemical, drug, or ingredient involved; the severity of symptoms, time of onset, nature of symptoms; the time and type of first-aid measures given; and the medical and psychiatric history. In most cases, the patient is unaware of exposure, confused, comatose, or unable or unwilling to admit to one. Suspicious circumstances include unexplained sudden disease in a previously healthy person or a group of healthy people; a history of psychiatric problems (especially depression); current changes in health, social relationships, economic status, or the onset of disease during work with chemicals or after ingestion of drink (especially ethanol), food, or medications. When patients become sick soon after arriving from a foreign country or being arrested for criminal activity, “body packing” or “body stuffing” (ingesting or concealing illicit drugs in a body cavity) should be suspected. Relevant information may be available from friends, paramedics, family, police, pharmacists, physicians, and employers, who should be queried regarding the patient’s, behavioral changes, habits, hobbies, available medications, and antecedent events. Patients have to be asked explicitly concerning their prescribed drugs and recreational medication use. Drugs previously considered “illicit” such as cannabinoids are now legal in many places and prescribed for therapeutic purposes. A search of belongings, clothes, and places of discovery may unveil a suicide note or a container of chemicals or drugs. Without an apparent history in a patient clinically suspected to be poisoned, all drugs available anywhere in the patient’s home or belongings should be considered as possible agents, including drugs for pets. The label on chemical products or the imprint code on drugs may be used to identify the potential toxicity of a suspected poison by consulting the manufacturer, a reference text, a computerized database, or a regional poison information center (800-222-1222). However, poisoning can mimic other illnesses, the correct diagnosis can usually be established by the history, physical examination, routine and toxicologic laboratory evaluations, and characteristic clinical course.

High-Dose Poisoning, “Body Packers” Case That Ended in An Emergency: A Case Report

High-Dose Poisoning, “Body Packers” Case That Ended in An Emergency: A Case Report

Fatality in a body packer: the first reported case in Saudi Arabia

BackgroundBody packers use different methods and materials to pack drugs inside their bodies. These could be simple or sophisticated to ensure a successful transfer or concealment of the drug with minimal risk to the packer. Different drugs were reported with cocaine and heroin being the most common. The packer presents to health facilities whenever they develop complications like drug leakage or intestinal obstruction, or they can be detected after a fatal event as an incidental finding in autopsy.Case presentationA body packer who was in detention suffered pain and died shortly after that. The autopsy not only revealed severe coronary atherosclerosis but also unveiled 10 rubber packages filled with methamphetamine and cannabis, and one package was found ruptured in the mouth. Toxicological analysis showed a blood level of methamphetamine 3.66 mg/L which was considered a cause of death. While methamphetamine was reported in cases of body packers, cannabis is rarely concealed by body packers for several reasons including its cost compared to the risk of packing.ConclusionsThis is the first reported case of fatality in body packers in Saudi Arabia and Arab countries. This should put into consideration the need for screening suspicious cases who are involved or suspected to be involved with drugs. Effective screening in specific facilities is needed to reduce fatalities and at the same time lowering drug smuggling.

Influence of Compression Molding Process Parameters in Mechanical and Tribological Behavior of Hybrid Polymer Matrix Composites

In recent days, natural fibers are extremely influential in numerous applications such as automobile body building, boat construction, civil structure, and packing goods. Intensification of the properties of natural fibers is achieved by blending different natural fibers with resin in a proper mixing ratio. This investigation aims to synthesize a hybrid polymer matrix composite with the use of natural fibers of flax and loops of hemp in the epoxy matrix. The synthesized composites were characterized in terms of tribological and mechanical properties. The Taguchi L16 orthogonal array is employed in the preparation of composite samples as well as analysis and optimization of the synthesis parameters. The optimization of compression molding process parameters has enhanced the results of this investigation. The parameters chosen are percentage of reinforcement (20%, 30%, 40%, and 50%), molding temperature (150 °C, 160 °C, 170 °C, and 180 °C), molding pressure (1 MPa, 2 MPa, 3 MPa, and 4 MPa), and curing time (20 min, 25 min, 30 min, and 35 min). From the analysis, it was observed that the percentage of reinforcement is contributing more to altering the fatigue strength, and the curing time is influenced in the impact and wear analysis.

"Body stuffing" and "Body packing" - Forensic control of human excrements in police custody in Hamburg, Germany.

Different methods are used to confiscate evidence whenever suspected body packers or body stuffers are taken into custody. Among these, controlled defecation and analysis of drug toilets from suspects has proved to be safe given that no invasive or forceful procedures are applied. All records of "drug toilet" evaluations done at the Hamburg Institute of Legal Medicine from January 1st 2018 to April 30th 2021 were descriptively analyzed for the individual's age, sex, country of origin, and whether the drug toilets contained any drug "balls", packages or containers. In case of a positive finding, the total number of balls found were recorded. Special cases are presented in detail for illustrative purposes. Drug toilets from 72 suspects were examined in the period under review. 98.6% (n=71) of the suspects were males and relatively young with approximately two-thirds (62.5%, n=45) aged 34years or below (range 18-50years). The majority of suspects originated from African countries (72.2%, n=52). The typical drug balls or containers were found in 13 (18.1%) of the examined drug toilets. Negative drug toilets might indeed indicate that the suspect had not ingested any drug packages at the time of arrest or while in custody. However, multiple excretions, voluntary delay of defecation, use of drugs to delay the excretion process or even individual differences in excretion times are possible, and therefore, a negative drug toilet should not always imply with certainty that the individual in question had not ingested any drugs.

EP.FRI.306 The Mule who took us for a ride

Abstract Introduction Foreign body ingestion is not uncommon in patients with mental disorders, alcohol intoxication and for purposes of drug trafficking. Small objects pass spontaneously; however, larger ones may get stuck in the oesophagus, stomach or at narrow areas of the bowel. "Body packers" is a term used to describe persons who swallow or insert drug-filled packets into a body cavity. They are also called “swallowers”, “internal carriers” “couriers” or “mules”. Case report We report a 37 year old previous drug abuser who presented with dysphagia. Upper GI endoscopy showed an oblong foreign body covered in plastic in the lower oesophagus. This could not be extracted and hence was pushed into the stomach. Three weeks later, he presented with bowel obstruction that was shown on abdominal radiograph and confirmed by CT indicating multiple dilated small bowel loops with a transition point in the terminal ileum where the ingested package was identified. The package was then removed through a longitudinal enterotomy. Conclusion Ingested foreign bodies causing dysphagia should ideally be extracted endoscopically. If not possible, then a watch and wait policy may be justified. While most ingested objects pass spontaneously, unusual and larger ones may require surgical extraction. The contents, nature and reason for ingesting this strange object remain a mystery. With history of drug abuse and the consistent denial of knowingly swallowing that object, we can only conclude that the patient was trying to transport an illicit drug in the packet. Keywords Foreign body ingestion, bowel obstruction, body packers.

A Five-year Report on Body Packing and Body Stuffing in Isfahan

Background: Body packing and body stuffing of illicit drugs have increased in recent decades. The drug contents of the packages vary from region to region, and there are controversies surrounding the diagnostic and therapeutic methods. The aim of this study was to explore the clinical presentations, diagnostic and therapeutic measures, and the subsequent clinical outcomes of drug concealment by people. Methods: A retrospective analysis was performed on data for all cases of body packing and body stuffing that were referred to a university hospital, in Isfahan, Iran, from Mar. 2013 to Feb. 2018. Results: Sixty-eight body stuffers and 18 body packers (n=86) were included in this study. Seventy-eight patients (90.7%) were male, mostly aged between 20 to 40 years. There was no significant difference between the two groups with respect to the signs and symptom, hospital stay, treatment and clinical outcomes. Heroin and crystal methamphetamine, n=52 (60%) and n=22 (25%), respectively, were the most substances detected, irrespective of the concealment method. Abdominal X-ray and CT scan tests were positive for the detection of at least one packet in each of the 94.4% of the patients. Conclusion: Heroin and crystal methamphetamine were the most common substances concealed in the bodies of the patients. Based on our findings, CT scan was more sensitive than abdominal X-ray test in the detection of illicit drug packets concealed in the patients. Close observation and whole bowel irrigation were effective therapeutic modalities in most cases. All cases were fully recovered and discharged from the hospital.