• Rocco Roberto Pidoto, Anna Maria Agliata, Roberto Bertolini, Alberto Mainini, Gianfranco Rossi, and Giuseppe Giani.
• Emergency Department, S. Antonio Abate Hospital, Gallarate, Italy.
• J Emerg Med. 2002 Aug 1; 23 (2): 149-53.

AbstractClinical outcome of cocaine body packers is considered to be unpredictable and there are no clear guidelines for the management of these patients. Their surveillance in casualty wards, where they are usually admitted during evacuation of the packets, can be very difficult. The authors refer to a new type of cocaine packet, allowing these patients to be managed with a more conservative approach than in the past, and report their experience with 161 body packers, observed from January 1999 to December 2000. They adopted a surveillance protocol providing only minimal medical intervention. Among 161 body packers, 142 (88.2%) evacuated the ingested packets without significant symptomatology. Warning symptoms were present in 19 (11.8%) patients. Three patients (1.9%) presented with marked anxiety but none had cocaine in the urine sample. Fifteen (9.3%) body packers complained of colicky pain, and all underwent plain X-ray studies of the abdomen. Ten (6.2%) of them without radiologic signs of intestinal occlusion recovered with food deprivation and medical treatment, while five (3.1%) underwent laparotomy, three patients (1.9%) for gastric occlusion and two (1.2%) for ileal occlusion. Only one patient (0.6%) had warning symptoms and a urine screen positive for cocaine metabolites. In three cases of gastric occlusion, a gastrotomy was accomplished. In two cases of ileal occlusion, and in the patient with cocaine intoxication, packets were milked into the cecum, and some into the descending colon and rectum, until anal expulsion, by gentle pulling. Type 4 packets represent a new method of cocaine packaging, carrying the possibility of treating these body packers more conservatively than those transporting previous type of packets. Surgical approach to intestinal occlusion also may be conservative, because distal propulsion of the packets can be accomplished without entering the intestine.

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