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Clinical A 28-year-old drug-addicted male presented with the complication of injection into his groin area (deep vein thrombosis). He was detained by law enforcement officers while referring to our centre.After admission to the hospital, he confessed to ingestion of about 40 pellets of opium. His abdominal X-ray is shown in Figure 1.How should this patient be managed? Figure 1. The patients plain abdominal X-ray shows multiple foreign bodies (stars). A thin, lucent rim of air (double-condom sign) outlines many packets (arrows) Answer and Discussion A body packer is an individual who ingests drugs of abuse (cocaine, heroin, marijuana, opium, crack, and ecstasy) in wrapped packets for the purpose of smuggling.1-3 Asymptomatic body packers usually present to medical services when arrested or taken into custody by law enforcement officers. Management of asymptomatic body packers has not been rigorously evaluated to date. Treatment by the administration of activated charcoal and whole bowel irrigation with poly ethylene glycol has often been advocated.1-5 Surgical intervention isindicated for the patients with illeus, perforation, or acute cocaine, marijuana, crack, and ecstasy poisoning. Also, it is indicated if the patient clinically deteriorates despite conservative management or when packets fail to progress through the gastrointestinal tract.1-5 We administered poly ethylene glycol lavage solution to the patient at a rate of 1 L/h for 8 hours under constant police surveillance. Customs agents collected 42 intact packets of opium. Repeated plain abdominal X-ray 24 hours later confirmed complete decontamination.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Hossein Sanaei-Zadeh, MD and Associate Professor; Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

Acknowledgements

Correspondence

Dr Hossein Sanaei-Zadeh, Medical School, Shiraz University of Medical Sciences, Emergency Room/Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Meshkinfam Street, 7143918796 Shiraz, Iran

Correspondence Email

sanaeizadeh@sums.ac.ir

Competing Interests

Sanaei-Zadeh H. Body packer with opiate toxicity. Intern Med J. 2009;39:776.de Bakker JK, Nanayakkara PW, Geeraedts LM Jr, et al. Body packers: a plea for conservative treatment. Langenbecks Arch Surg. 2012;397:125-130.Sanaei-Zadeh H. The suggested algorithm for the management of \"body packers\". Langenbecks Arch Surg. 2012;397:841-842.Prosser JM. Internal concealment of xenobiotics. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, et al. Goldfrank's Toxicologic Emergencies, 9th ed. New York: McGraw-Hill; 2011, p1103-1108.Glovinski PV, Lauritsen ML, Bay-Nielsen M, et al. Asymptomatic body packers should be treated conservatively. Dan Med J. 2013;60:A4723.

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Clinical A 28-year-old drug-addicted male presented with the complication of injection into his groin area (deep vein thrombosis). He was detained by law enforcement officers while referring to our centre.After admission to the hospital, he confessed to ingestion of about 40 pellets of opium. His abdominal X-ray is shown in Figure 1.How should this patient be managed? Figure 1. The patients plain abdominal X-ray shows multiple foreign bodies (stars). A thin, lucent rim of air (double-condom sign) outlines many packets (arrows) Answer and Discussion A body packer is an individual who ingests drugs of abuse (cocaine, heroin, marijuana, opium, crack, and ecstasy) in wrapped packets for the purpose of smuggling.1-3 Asymptomatic body packers usually present to medical services when arrested or taken into custody by law enforcement officers. Management of asymptomatic body packers has not been rigorously evaluated to date. Treatment by the administration of activated charcoal and whole bowel irrigation with poly ethylene glycol has often been advocated.1-5 Surgical intervention isindicated for the patients with illeus, perforation, or acute cocaine, marijuana, crack, and ecstasy poisoning. Also, it is indicated if the patient clinically deteriorates despite conservative management or when packets fail to progress through the gastrointestinal tract.1-5 We administered poly ethylene glycol lavage solution to the patient at a rate of 1 L/h for 8 hours under constant police surveillance. Customs agents collected 42 intact packets of opium. Repeated plain abdominal X-ray 24 hours later confirmed complete decontamination.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Hossein Sanaei-Zadeh, MD and Associate Professor; Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

Acknowledgements

Correspondence

Dr Hossein Sanaei-Zadeh, Medical School, Shiraz University of Medical Sciences, Emergency Room/Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Meshkinfam Street, 7143918796 Shiraz, Iran

Correspondence Email

sanaeizadeh@sums.ac.ir

Competing Interests

Sanaei-Zadeh H. Body packer with opiate toxicity. Intern Med J. 2009;39:776.de Bakker JK, Nanayakkara PW, Geeraedts LM Jr, et al. Body packers: a plea for conservative treatment. Langenbecks Arch Surg. 2012;397:125-130.Sanaei-Zadeh H. The suggested algorithm for the management of \"body packers\". Langenbecks Arch Surg. 2012;397:841-842.Prosser JM. Internal concealment of xenobiotics. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, et al. Goldfrank's Toxicologic Emergencies, 9th ed. New York: McGraw-Hill; 2011, p1103-1108.Glovinski PV, Lauritsen ML, Bay-Nielsen M, et al. Asymptomatic body packers should be treated conservatively. Dan Med J. 2013;60:A4723.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Clinical A 28-year-old drug-addicted male presented with the complication of injection into his groin area (deep vein thrombosis). He was detained by law enforcement officers while referring to our centre.After admission to the hospital, he confessed to ingestion of about 40 pellets of opium. His abdominal X-ray is shown in Figure 1.How should this patient be managed? Figure 1. The patients plain abdominal X-ray shows multiple foreign bodies (stars). A thin, lucent rim of air (double-condom sign) outlines many packets (arrows) Answer and Discussion A body packer is an individual who ingests drugs of abuse (cocaine, heroin, marijuana, opium, crack, and ecstasy) in wrapped packets for the purpose of smuggling.1-3 Asymptomatic body packers usually present to medical services when arrested or taken into custody by law enforcement officers. Management of asymptomatic body packers has not been rigorously evaluated to date. Treatment by the administration of activated charcoal and whole bowel irrigation with poly ethylene glycol has often been advocated.1-5 Surgical intervention isindicated for the patients with illeus, perforation, or acute cocaine, marijuana, crack, and ecstasy poisoning. Also, it is indicated if the patient clinically deteriorates despite conservative management or when packets fail to progress through the gastrointestinal tract.1-5 We administered poly ethylene glycol lavage solution to the patient at a rate of 1 L/h for 8 hours under constant police surveillance. Customs agents collected 42 intact packets of opium. Repeated plain abdominal X-ray 24 hours later confirmed complete decontamination.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Hossein Sanaei-Zadeh, MD and Associate Professor; Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

Acknowledgements

Correspondence

Dr Hossein Sanaei-Zadeh, Medical School, Shiraz University of Medical Sciences, Emergency Room/Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Meshkinfam Street, 7143918796 Shiraz, Iran

Correspondence Email

sanaeizadeh@sums.ac.ir

Competing Interests

Sanaei-Zadeh H. Body packer with opiate toxicity. Intern Med J. 2009;39:776.de Bakker JK, Nanayakkara PW, Geeraedts LM Jr, et al. Body packers: a plea for conservative treatment. Langenbecks Arch Surg. 2012;397:125-130.Sanaei-Zadeh H. The suggested algorithm for the management of \"body packers\". Langenbecks Arch Surg. 2012;397:841-842.Prosser JM. Internal concealment of xenobiotics. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, et al. Goldfrank's Toxicologic Emergencies, 9th ed. New York: McGraw-Hill; 2011, p1103-1108.Glovinski PV, Lauritsen ML, Bay-Nielsen M, et al. Asymptomatic body packers should be treated conservatively. Dan Med J. 2013;60:A4723.

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