Hospital: Hospital General Morales Meseguer, Hospital General Universitario Santa Lucía.
Aut@r o Autores: I. González-Moreno, J. Trejo-Falcón, M. Fernández-Ferrando, C. Botía-González, A. Barceló-Cárceles, I. Herves-Escobedo.
A 32-year-old male arrived at the Emergency Department with diffuse abdominal pain after having swallowed 42 hashish packets five days ago. He suffered prolonged constipation despite having taking mild laxatives. The clinical examination was anodyne, but laboratory test showed a mild leukocytosis. Plain abdominal film revealed multiple ovoid opacities in the small bowel with a diameter close to 5 cm and air-stool attenuation. Pneumoperitoneum was not observed. He was initially treated conservatively. However, during the following hours the patient worsened clinically and a contrast-enchanced multidetector computer tomography (MDCT) was performed. It did not show signs of perforation or obstruction. Because the patient continued symptomatic he required surgical intervention to prevent possible complications.
Body packing is defined as smuggling drugs within the human body(1). The simplest way to detect drug-filled packets in the intestine is plain X-ray of the abdomen(1, 2). This is why radiologist need to know how to interpret radiographs of possible body packers. Most typical findings are: well-defined opacities in the stomach, small bowel or large bowel not suggestive of alimentary content, the “double- condom sign”, defined as a clear crescent of air bordering an ovoid opacity, a smooth and uniformly shaped oblong structure (the “tic-tac sign”), or the “parallelism sign”, defined as firm packages aligning parallel to each other in the bowel lumen(1, 2). The radiological density of a drug is variable and depends on its composition and grade of purity(1, 2). MDCT has a higher potential to detect drug packets, but it is normally used when small bowel obstruction or perforation are suspected(2). It is not appropriate as an initial screening procedure because of the excessive ionizing radiation burden(1, 2). In fact radiologists should be familiar with the medicolegal situation in their country relating to the use of ionizing radiation without a medical indication. In some European countries, informed consent must be obtained prior to undergoing the test, while in others theimaging tests may be conducted at the request of a customs officer and/or following a judicial injunction(1, 2).
Radiologists have a key role in the identification of body packers and their potential complications. The medicolegal situation of the country should be checked previous to the examination.
- Hergan K, Kofler K, Oser W. Drug smuggling by body packing: what radiologists should know about it. Eur Radiol. 2004,14:736-42. DOI 10.1007/s00330-003-2091-5 - Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, et al. Radiological and pract