Conservative treatment for asymptomatic body packers?

September 10, 2014, 5:32 pm

Body packer

Body packer

★★☆☆☆

Asymptomatic body packers should be treated conservatively. Glovinski PV et al. Dan Med J 2013 Nov;60:A4723

Abstract

Kudos to the authors for putting their general conclusion in the title. Unfortunately, there’ s less here than meets the eye.

This is a retrospective review of 57 patients suspected of body packing, seen at Hvidovre Hospital in Denmark. However, actual body packing was confirmed in only a little over half of these cases, meaning this is really a study of only 29 patients.

All confirmed body packers were admitted, given a laxative and “monitored using a scope.” (I’m not quite sure what this means. After passing two stools not containing packets, they received a non-contrast CT to confirm that the GI tract was clear. The treatment protocol indicated surgery only for GI tract obstruction or evidence of drug intoxication suggesting packet rupture.

No patient developed signs or symptoms of obstruction or rupture, and none required surgery. One patient treated conservatively did not clear his GI tract until the 17th hospital day.

There is a consensus in recent literature that surgery in body packers is generally not required. Certainly, evidence of GI tract obstruction or packet rupture is an indication. The open question is whether delayed progression of drug packets calls for surgery. The authors note that some studies have recommended surgery for packets retained more that 5-7 days.

The authors conclude that, based on their study “Package retention per se is not an indication for emergency operation.” I think they are probably correct, but since their study included as few as a single patient with delayed passage and retention, it is not a conclusion that is ready for prime time.
Related posts:

Body packers: can CT determine the number of drug packets?

MRI for body packers?

Low-dose abdominal CT is superior to plain film for imaging suspected body packers

Cannabis body packers

Treatment protocol for symptomatic body packers (mules)

Cocaine mules: what to do with body packers

 

 

 

 

 

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