Patient who is a drug trafficker can
present to emergency department as a variety presentation ranging from acute
abdomen to abnormal behavior. A high index of suspicion is the only clue to
diagnosed drug trafficker. A 21-year-old oversea female with no
known medical illness, was brought in by police officer to the ED of Hospital XX after receiving a public complaint of displaying indecent
behavior in the public. Further history from the police reveals that she was
naked in the Chow Kit area and behaving aggressively.
On examination, she looked calm with no
aggressive behavior. She was talking coherently, and she complained of mild
colicky abdominal pain. Denying of behaving abnormally as well as denying of
taking any substance abuse, she said that she had just arrived in Kuala Lumpur
by flight yesterday. Otherwise, her physical examination
was uneventful and her vital signs were normal. Urine
for amphetamine was positive and abdominal radiograph showed multiple oval to elongated
radioopaque foreign bodies in the small and large bowels (Figure 1). Upon probing further, she admitted to swallowing 80 packets of amphetamine
for transportation (Figure 2). The
diagnosis of drug body packing with concomitant substance abuse was made. She was to the ED observation ward
for 5 days, during which, a total of 60 packets of amphetamine were passed out
after using adequate laxatives. She was discharged well back to the police
custody on day 5 after admission.
In the ED, cases of missed diagnosis
of body packing may occur due to hectic activities, lack of manpower as well as
lack of experience, especially among junior doctors. Therefore, it
is vitally important for junior doctors to be aware of the clinical
manifestations of body packer syndrome so that early recognition and diagnosis
can be made. Recent increase in the number of drug trafficking in the United
States and around the world have led to increase security measures beefed up at
national borders. This leads to increasing cases of drug smugglers using
children as couriers, including using them as "body packers".
In conclusion, doctors may miss this
type of gastrointestinal foreign body if they are not aware of the “body packer
syndrome”. Body packing should be suspected in anyone with signs of
drug-induced toxic following recent arrival at city terminals or when there is denial
of recent history of recreational drug use.
FIGURE 1
FIGURE 2
