UMEM Educational Pearls

Title: Utility of CT abdomen/pelvic (with or without PO contrast) to identify body stuffer and body packers.

Keywords: body stuffer, body packer, CAT Scan (PubMed Search)

Posted: 10/15/2015 by Hong Kim, MD, MPH
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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:

Positive: 7 (sensitivity 29.2%)
Negative: 17

CT w/o PO contrast:

Positive: 9 (sensitivity 36.5%)
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.