Cocaine body packer: a case report

Abstract

Objective: A body packer is a person who ingests pouches or packages of psychoactive substances (usually cocaine) to transport it. International smuggling of cocaine via body packers is an increasing problem worldwide. It is a very dangerous method to transport cocaine, since there is a high risk of package rupture inside the body, leading to overdose and sudden death. We report a case of a man who ingested and tried to transport 90 cocaine packages from South America to Europe. Case report: A 27-year-old man was brought to the emergency department by customs police officers from Vilnius airport with a suspicion of psychoactive substances transportation via packages inside his body. He was travelling from French Guiana to Latvia with stopovers in Paris and Lithuania. When airport customs officers suspected him of being a body packer, he denied an illegal transportation of drugs and agreed to be examined by clinical toxicologists in Republic Vilnius University Hospital. Upon admission he was conscious, oxygen saturation was 99%, blood pressure 135/84 mmHg, and heart rate 99 beats per minute. There was no evidence suggesting an acute intoxication. Laboratory tests were without clinical changes. Psychoactive drug tests were also negative. Plain abdominal radiography suggested intensive multiple shadows with clear boundaries present inside the colon. To confirm the suspicion of body packing, an abdomen and pelvic computerised tomography (CT) scan was done. It revealed multiple ingested foreign bodies (up to 90) distributed from the caecum to the rectum. When the case was confirmed, the patient admitted that he was carrying 90 packages of diameter 3.5 1.5 cm. After half an hour he started eliminating the packages. The patient was hospitalized in the acute poisoning department. The decision was made not to use any medication to stimulate faster elimination of packages and let them leave the body naturally, however precautions were made, including heart rate monitoring and personnel supervision. The packages were successfully eliminated in two days and the patient was discharged back to law enforcement. Conclusion: Even though there are recommendations to induce faster gut clearance of foreign bodies using medication it can be done naturally. It is also important to take precautions such as heart rate monitoring to register tachycardia in a case of package rupture as well as personnel supervision to ensure a rapid response if packages leak and clinical signs occur.