Body-Packing: A Rare Diagnosis to Keep in Mind
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Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation.

The authors present the case of a 50-year-old healthy man, born in Cape Verde, who was admitted in the emergency department due to an inaugural generalized tonic-clonic seizure. The patient presented with marked psycho-motor agitation, confused speech, hypertension and tachycardia. Because he was vomiting with plastic film, a nasogastric tube was placed with drainage of white powder residue. An x-ray of the abdomen showed the presence of multiple foreign bodies in the stomach and colon.

A CT scan of the abdomen also revealed multiple radio-dense packages filling the entire stomach and colon. Due to the suspicion that this was a body-packing case, blood and urine tests for toxic substances were requested and revealed urinary cocaine levels of 9,363 ng/ml at admission and 26,400 ng/ml after 12 hours (reference value less than 300 ng/ml), which confirmed the diagnosis of cocaine intoxication. The patient underwent immediate exploratory laparotomy, with the removal of 71 packages of cocaine. His clinical course during hospitalization was favourable.

Despite substance protection techniques, the risk of rupture is directly proportional to the number of packages carried. Clinical suspicion followed by imaging are essential for the diagnosis of this potentially fatal practice, which we believe to be increasing.

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