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.