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Toxicity due to body packing and body stuffing can be a significant concern due to unknown quantity and/or substance that was ingested.
- Body stuffers usually ingest small quantities of poorly wrapped illicit substance (intended for sale) to evade law enforcement.
- Body packer ingests large quantities of well-packaged illicit substance for trafficking purpose. Rupture of these packets can potentially result in fatal toxicity.
A recent prospective observational case series compared the utility of CT abdomen/pelvis with and without PO contrast in identifying the ingested packets.
The gold standard comparison: surgical removal or expulsion of packets.
All patients received CT abd/pelvis with and without PO contrast.
A. Body stuffers (n = 24)
CT w/ PO contrast:
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Positive: 7 (sensitivity 29.2%)
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Negative: 17
CT w/o PO contrast:
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Positive: 9 (sensitivity 36.5%)
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Negative: 15
All 24 patients passed ingested packets
B. Body packers (n= 11)
CT w/ PO contrast
- Positive: 6 (sensitivity 60%)
- Negative: 5
CT w/p PO contrast
- Positive: 7 (sensitivity 70%)
- Negative: 3
10 patients expulsed packets; one patient did not have any packets.
Conclusion
- CT without PO contrast was better at identifying the ingested packets in both body stuffers and packers.
Bottom line:
- CT abdomen/pelvis has limited clinical utility in identifying the packets (presence) among body stuffers. If symptomatic, appropriate supportive care should be initiated
- Among packers who may experience life-threatening toxicity from the leakage/rupture of the packets, CT may be helpful to confirm the presence of packets and to follow the progress of expulsion of packets.
- Caution should be exercised as CT did not identify packets (body stuffer or packers) in all patients in this case series.
References
Shahnazi M et al. Comparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers. Clin Toxicol 2015;53:596-603.