Atención médica de body packers en un territorio colombiano / Medical care for body packers in a Colombian territory

Introducción. El número de capturas a los body packers, que son aquellas personas que ingieren paquetes con estupefacientes para tráfico ilegal, ha aumentado paulatinamente. El objetivo de este estudio fue presentar los casos de body packers atendidos en dos instituciones de salud de Florencia, un territorio al sur de Colombia, entre 2003 y 2017. Métodos. Este es un estudio retrospectivo descriptivo. Se hizo un análisis univariado en RStudio y Microsoft Excel® de variables sociodemográficas y clínicas. Se emplearon medidas de tendencia central y dispersión para las variables continuas, frecuencias y proporciones para las variables categóricas. Resultados. Se incluyeron 72 pacientes. La mayoría de los casos fueron reportados entre 2007 y 2012 (77,5 %). La relación entre hombres y mujeres fue de 4,9:1. La edad media fue de 29,1 años. El principal motivo de admisión fue para chequeo médico tras captura por parte de los organismos de seguridad nacional (76,4 %). En 9 de cada 10 admitidos se realizaron estudios de imagen (94,4 %); la principal ayuda diagnóstica fue la radiografía de abdomen simple (84,7 %), con una sensibilidad del 91,6 %. Se realizó manejo expectante en tres de cada cuatro pacientes (74,6 %). El 6,9 % presentaron complicaciones, con una mortalidad (1,4 %). Conclusiones. La radiografía de abdomen simple es una ayuda diagnóstica adecuada para el tamizaje de los body packers. El manejo conservador es aceptable, teniendo en cuenta el porcentaje bajo de complicaciones.

Introduction. The number of arrests of body packers, who are those people who ingest packages with narcotics for illegal trafficking, has gradually increased. The objective of this study was to present the cases of body packers treated in two health institutions in Florencia, a territory in southern Colombia, between 2003 and 2017. Methods. This is a descriptive retrospective study. A univariate analysis was performed in RStudio and Microsoft Excel® of sociodemographic and clinical variables. Measures of central tendency and dispersion were used for continuous variables, frequencies and proportions for categorical variables. Results. 72 patients were included. Most cases were reported between 2007 and 2012 (77.5%). The ratio between men and women was 4.9:1. The mean age was 29.1 years. The main reason for admission was for medical check-up after capture by national security agencies (76.4%). In nine out of ten admitted patients, imaging studies were performed (94.4%); the main diagnostic imaging was simple abdominal X-ray (84.7%), with a sensitivity of 91.6%. Expectant management was performed in three out of four patients (74.6%). 6.9% presented complications, with one mortality (1.4%). Conclusions. Simple abdominal x-ray is an adequate diagnostic tool for screening body packers. Conservative management is acceptable, taking into account the low percentage of complications.

Síndrome pilórico en un body packer / Pyloric syndrome in a body packer

Introducción. El embalaje y transporte de estupefacientes dentro del organismo, o body packing, es una práctica frecuente en Centroamérica y el Caribe. Además del riesgo de muerte por la exposición a las sustancias tóxicas, existe el riesgo de complicaciones mecánicas con indicación de manejo quirúrgico. El Hospital de Engativá, por su cercanía al aeropuerto de Bogotá, D.C., Colombia, es el centro de referencia para el tratamiento de estos pacientes. Caso clínico. Un hombre de 65 años traído al hospital por un episodio emético con expulsión de cuatro cápsulas para el transporte de estupefacientes. Al examen físico se encontraron masas palpables en el hemiabdomen superior, sin abdomen agudo. La tomografía de abdomen informó un síndrome pilórico secundario a retención gástrica de cuerpos extraños. Fue llevado a laparotomía y gastrotomía logrando la extracción de 97 objetos cilíndricos de látex que contenían sustancias ilícitas. Discusión. En los body packer asintomáticos, la administración de soluciones laxantes es una estrategia terapéutica segura. Los casos reportados de obstrucción gastrointestinal son infrecuentes y se relacionan con la ingesta de un gran número de cápsulas, por lo que es necesario el tratamiento quirúrgico. Conclusión. El síndrome pilórico es una presentación infrecuente en un body packer. Se debe tener un alto índice de sospecha para garantizar un manejo oportuno

Introduction. Packaging and transportation of narcotic drugs inside a human body, or body packing, is a frequent practice in Central America and the Caribbean. In addition to the risk of death due to exposure to toxic substances, there is a risk of mechanical complications with an indication for surgical management. The Engativá Hospital, due to its proximity to the airport in Bogotá, D.C., Colombia, is the reference center for the treatment of these patients. Clinical case. A 65-year-old man brought to the hospital for an emetic episode with expulsion of four narcotic transport capsules. Physical examination revealed palpable masses in the upper abdomen, without an acute abdomen. Abdominal tomography revealed pyloric syndrome secondary to gastric retention of foreign bodies. He was taken to laparotomy and gastrotomy, achieving the extraction of 97 cylindrical latex objects that contained illicit substances. Discussion. In asymptomatic body packers, the administration of laxative solutions is a safe therapeutic strategy. Reported cases of gastrointestinal obstruction are infrequent and are related to the ingestion of a large number of capsules, for which surgical treatment is necessary. Conclusion. Pyloric syndrome is an uncommon presentation in body packers. A high index of suspicion is required to ensure timely management

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond.

INTRODUCTION: Body packing consists of the concealment of substances (drugs and non-narcotics) or products inside the human body with the purpose of smuggling and may represent an emergency due to the fatal risk of narcotic toxicity, intestinal obstruction, and visceral perforation. However, non-narcotic body packing, especially in developing countries, is under-evaluated. Thus, the objective of this study was to evaluate cases of body packers in Brazil as regards narcotic and non-narcotic contents. METHODS: This retrospective study analyzes the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil. RESULTS: Ten cases of body packing were observed. We found that five patients carried drugs, while seven carried non-narcotic substances such as cell phones and accessories. All the patients were male, prisoners, and young adults. In six patients, there was gastrointestinal obstruction, and in three, there was acute narcotic intoxication. Abdominal radiography diagnosed eight of the cases. In nine of the cases, emergency laparotomy was required, but all patients successfully recovered. CONCLUSION: There was a higher prevalence of body packing of non-narcotic content; however, diagnostic and surgical approaches were similar to those of narcotic content. Clinicians must be aware of both non-narcotic and narcotic body packing.

Body Packer y Body Stuffer: Serie de Casos. Revisión / Body Packer y Body Stuffer: serie de casos. Revision

"Body packing", "Body pushing" y "Body stuffing" son distintas formas de transportar sustancias ilegales dentro del cuerpo humano. Frente al ingreso en la unidad de emergencias de un "Body Packer", conocido como "tragador de paquetes" con fines de contrabando o un "Body Stuffer" llamados "tragadores rápidos", quienes ingieren en forma compulsiva paquetes manufacturados para la venta de sustancias ante la posibilidad de ser sorprendidos por agentes de la ley; se plantean una serie de desafíos en cuanto al tratamiento que al día de hoy permanecen en debate. Generalmente se prefiere mantener una conducta conservadora facilitando la expulsión de los paquetes. En aquellos casos en los que los pacientes presenten paquetes atascados o rotos o no mejoren con el tratamiento conservador, se recomienda el tratamiento quirúrgico.El presente trabajo tiene por objetivo reportar una serie de casos internados por ingesta de paquetes potencialmente peligrosos que se sometieron a una evacuación farmacológica y/o quirúrgica en 8 pacientes y una revisión bibliográfica sobre el tema.

"Body packing", "Body pushing", and "Body stuffing" are different ways to use the interior of the human body to transport illegal substances. In the face of a "Body Packer" or a "Body Stuffer" known as "fast swallowers", which are those cases in which they compulsively swallow manufactured packages for the sale of substances before the possibility of being surprised by law enforcement officers, a series of challenges present themselves regarding the treatment, which is currently up for debate. Generally, a conservative conduct is preferred, facilitating the expulsion of the packages. In those cases, in which patients have stuck or broken packages or do not improve with conservative treatment, surgical treatment is recommended.The present paper aims to report a series of cases in which the patients were admitted due to an intake of potentially dangerous packages and put through a pharmacological evacuation and/or surgical evacuation of 8 patients, and a bibliographical revision on the subject.

Epidemiology and medical management of body-packers in French Guiana between 2010 and 2015.

Background: French Guiana is used as a drug trafficking pipeline of cocaine to Europe. The number of arrests for transporting cocaine in corpore has increased exponentially in recent years. Since 2010, Cayenne Hospital's emergency care unit has applied a medical management protocol system for body-packers. Our objective was to describe the epidemiology of body-packers and to evaluate medical management. Method: A retrospective descriptive study was performed among patients hospitalized in Cayenne Hospital for transporting cocaine in corpore between January 2010 and November 2015. In addition, a qualitative study including interviews of body-packers imprisoned in Rémire-Montjoly prison was conducted in April 2016. Result: A total of 282 patients were included in the study. The median age was 24 years and the sex ratio M/W was to 4/1. Among them, 3.5% showed signs of severity (9 with pre-existing condition and 1 with severe form). No surgery or deaths were reported. Ten endoscopies were performed because of the delay in evacuation without complications. Approximately 28% of patients had urinary screening, of which 60.7% were positive. The median length of stay was 1.8 days. Prolonged length of stay was significantly associated with the presence of gastrointestinal symptoms, hypoglycemia, or having swallowed a minimum of 10 pellets. Conclusion: This study led to a change in the management of body-packers in the hospital setting in Guiana. A computed tomography scan at discharge became more prevalent. Endoscopy has emerged as an effective and safe alternative to surgery. Despite the increase in the number of patients treated, it should be noted that there were few complications and no deaths in our cohort.

Body packing: tráfico de drogas y cirugía. Reporte de un caso / Body packing: drug traffic and surgery. Case report

Resumen Objetivo: Exponer el caso de un paciente con intoxicación aguda por cocaína en contexto de un body packing syndrome, considerando sus aspectos médico-quirúrgicos y legales. Materiales y Método: Se obtuvo la ficha clínica, con resguardo de anonimato, de un paciente que acude al servicio de urgencia (SU) y que es intervenido y evolucionando posteriormente en el Hospital el Pino de San Bernardo, Chile. Resultados: Paciente fue sometido a una gastrotomía, una enterotomía y una colotomía después de haber sido estabilizado por paro cardiorrespiratorio presentado en SU. Es trasladado a unidad de cuidados intensivos (UCI) donde evoluciona desfavorablemente. Discusión: El body packing syndrome es una entidad clínica infrecuente que, en la minoría de los casos, puede presentar complicaciones severas que requieren de un tratamiento médico-quirúrgico inmediato. Conclusión: Considerando que tanto el consumo como el tráfico de drogas se mantienen como un importante problema de salud pública y que sus consecuencias pueden ser devastadoras, es importante tener conocimiento sobre el tema.

Aim: To present the case of a patient with acute cocaine intoxication in the context of body packing syndrome, taking into consideration its medical-surgical and legal aspects. Materials and Method: A clinical record with anonymity protection was obtained, from a patient who was admitted to the emergency room and who was subsequently operated on and managed at Hospital El Pino in San Bernardo, Chile. Results: Patient underwent a gastrotomy, an enterotomy and a colotomy after being stabilized from a cardiorespiratory arrest in the emergency room. He was transferred to the Intensive Care Unit (ICU) where he evolved unfavorably. Discussion: Body packing is an infrequent clinical entity that, in a few cases, may develop severe complications that require immediate medical-surgical treatment, in addition to notification to authorities. Conclusion: Considering that both drug use and traffick remain as an important public health concern and that as its consequences may be devastating, it is important to have a knowledge on the subject.

Tratamiento médico del "body packer" entre los años 2014 y 2016 en un hospital universitario del caribe colombiano / Medical management of the "body packer" at a university hospital in the colombian caribbean in the period 2014-2016

Introducción. El término "body packer" hace referencia a sujetos portadores de objetos intraabdominales extraños, que contienen drogas ilícitas con fines de contrabando. La mayoría son pacientes asintomáticos, en quienes se instaura conducta expectante, observación clínica estrecha y administración de medicamentos para la evacuación de los paquetes, con miras a prevenir posibles complicaciones, como obstrucción intestinal o intoxicación, asociadas a su transporte intraabdominal. Materiales y método. Se llevó a cabo un estudio transversal de linealidad retrospectiva en pacientes admitidos en la E.S.E Hospital Universitario del Caribe entre los años 2014 y 2016,bajo la sospecha diagnóstica de "body packer". Luego de una revisión de las bases de datos institucionales se analizaron variables demográficas y clínicas de los sujetos incluidos en el estudio. Resultados. Se incluyeron 4 pacientes de género masculino, entre los 22 y 66 años de edad. La cantidad de cápsulas transportadas en promedio fue de 43, para una máxima de 74. La cocaína fue la sustancia que más se identificó. Para la evacuación de los paquetes se empleó irrigación intestinal con polietilenglicol. El tiempo de evacuación máximo fue de 48 horas y no hubo complicaciones asociadas al manejo proporcionado. Discusión. Estudios respecto al tema, como este, confirman la seguridad del manejo conservador del paciente asintomático y apoyan el uso de polietilenglicol dada su efectividad para lograruna limpieza intestinal completa y por su bajo riesgo de complicaciones asociado a su uso en comparación con otros métodos, así como la menor necesidad de intervenciones quirúrgicas. Se requieren estudios prospectivos aleatorizados controlados a partir de los cuales se determinen, con base en mayor evidencia, las mejores prácticas a seguir

Introduction. The term "body packer" refers to subjects carrying intraabdominal foreign objects that contain illicit drugs for contraband purposes. The majority of patients are asymptomatic, in whom expectant management is established, with close clinical observation and administration of medications for evacuation of the packages, with prevention of possible complications such as intestinal obstruction or intoxication associated with intraabdominal transport. Materials and method. A retrospective linearity cross sectional study was carried out in patients admitted to the Hospital Universitario del Caribe, Cartagena, Colombia, under the diagnostic suspicion of "body packer" in the period 2014 and 2016. After a review of the institutional databases, demographic and clinical variables of the study subjects were analyzed. Results. Four patients were included, male, ages 22 to 66 years. The average number of capsules transported was 43, with maximum of 74. Cocaine was the substance mainly identified. Intestinal irrigation with polyethylene glycol was used for intestinal evacuation. The maximum evacuation time was 48 hours and there were no complication associated with the given management. Discussion. The existing studies on the subject, as well as this one, confirm the safety of the conservative management in the asymptomatic patient and support the effectiveness of polyethyleneglycol in achieving complete intestinal cleansing and the low risk of complications associated with its use with respect to other methods, together with diminished need for surgical intervention. Controlled randomized prospective studies are required to provide greater evidence in order to determine the best practice to be followed