Enhancing Diagnostic Accuracy in Body Packing Cases: The Impact of Preliminary Diagnosis Awareness on Computed Tomography Evaluation

Abstract

Objective: Body packing refers to the concealment of illegal substances within the body. This study aims to evaluate the computed tomography (CT) findings of body packing cases, and to assess whether considering the possibility of body packing in preliminary diagnosis will affect the accuracy of specialists evaluating in the emergency and intensive care departments. Materials and Methods: 20 body packing cases were retrospectively examined for the presence of foreign bodies. A control group was created from 20 non-contrast abdominal CT images. Re-evaluation involved four radiologists. Before evaluating, two radiologists were advised they could be body packers. Results: In 18 (90%) of 20 body packers, foreign bodies were visible in the intestinal lumen, mostly 14 (70%) in the colon. Radiologists who were given preliminary diagnosis, correctly identified all 18 (100%) intestinal foreign body cases and did not make any false positives. Two other radiologists correctly identified 16 (88.9%) cases and missed 2 (11.1%) cases and there was significantly difference (p<0.001). Conclusions: In conclusion, packaged foreign bodies being observed most commonly in colonic segments. Evaluating without knowledge of the preliminary diagnosis of body packing significantly reduces the diagnostic accuracy. Keeping body packing cases in mind in emergency and intensive care departments in centers where they may be more prevalent can increase the diagnostic rate. When a tentative diagnosis is known, there is a greater chance of finding foreign bodies on CT scans, which increases diagnostic accuracy. This is especially true in high-prevalence settings where emergency and intensive care units may experience body packing.

Keywords

• Body Packing
• Computed Tomography
• Pre-Diagnosis
• Foreign Bodies / diagnosis
• Drug Trafficking
• Gastrointestinal Tract

References

1. Deitel M, Syed AK. Intestinal obstruction by an unusual foreign body. Can Med Assoc J. 1973; 109(3):211-12.
2. Pidoto RR, Agliata AM, Bertolini R, Mainini A, Rossi G, Giani G. A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers. J Emerg Med. 2002; 23(2):149-53.
3. Traub SJ, Hoffman RS, Nelson LS. Body packing--the internal concealment of illicit drugs. N Engl J Med. 2003; 349(26):2519-26.
4. Takekawa K, Ohmori T, Kido A, Oya M. Methamphetamine body packer: acute poisoning death due to massive leaking of methamphetamine. J Forensic Sci. 2007; 52(5):1219-22.
5. Nacca N, Schult R, Loflin R, et al. Coma, Seizures, Atrioventricular Block, and Hypoglycemia in an ADB-FUBINACA Body-Packer. J Emerg Med. 2018; 55(6):788-91.
6. Cawich SO, Downes R, Martin AC, Evans NR, Mitchell DI, Williams E. Colonic perforation: a lethal consequence of cannabis body packing. J Forensic Leg Med. 2010; 17(5):269-71.
7. Yegane RA, Bashashati M, Hajinasrollah E, Heidari K, Salehi NA, Ahmadi M. Surgical approach to body packing. Dis Colon Rectum. 2009; 52(1):97-103.
8. Alfa-Wali M, Atinga A, Tanham M, Iqbal Q, Meng AY, Mohsen Y. Assessment of the management outcomes of body packers. ANZ J Surg. 2016; 86(10):821-25.

9. van Geloven AA, van Lienden KP, Gouma DJ. Bodypacking--an increasing problem in The Netherlands: conservative or surgical treatment? Eur J Surg. 2002; 168(7):404-409.
10. Honar BN, Mollaverdi G, Aghajanian S, Bagherpour JZ. Bowel obstruction in body-packing: A case report and literature review. Int J Surg Case Rep. 2023; 109:108503.
11. Mandava N, Chang RS, Wang JH, et al. Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules). Emerg Med J. 2011; 28(2):98-101.
12. Booker RJ, Smith JE, Rodger MP. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J. 2009; 26(5):316-20.
13. Olumbe AK, Kalebi AY. Death from body packer syndrome: case report. East Afr Med J. 2004; 81(4):218-20.
14. Gill JR, Graham SM. Ten years of "body packers" in New York City: 50 deaths. J Forensic Sci. 2002; 47(4):843-46.
15. Bulstrode N, Banks F, Shrotria S. The outcome of drug smuggling by 'body packers'--the British experience. Ann R Coll Surg Engl. 2002; 84(1):35-38.
16. Bulakci M, Kalelioglu T, Bulakci BB, Kiris A. Comparison of diagnostic value of multidetector computed tomography and X-ray in the detection of body packing. Eur J Radiol. 2013; 82(8):1248-54.
17. Pinto A, Reginelli A, Pinto F, et al. Radiological and practical aspects of body packing. Br J Radiol. 2014; 87(1036):20130500.
18. Shahnazi M, Sanei Taheri M, Pourghorban R. Body packing and its radiologic manifestations: a review article. Iran J Radiol. 2011; 8(4):205-10.
19. Bulakci M, Cengel F. The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools. Br J Radiol. 2016; 89(1060):20150888.
20. Rousset P, Chaillot PF, Audureau E, et al. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study. Eur Radiol. 2013; 23(8):2146-55.
21. Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M. Body packing: a review of general background, clinical and imaging aspects. Radiol Med. 2015; 120(1):118-32.
22. Bulakci M, Ozbakir B, Kiris A. Detection of body packing by magnetic resonance imaging: a new diagnostic tool? Abdom Imaging. 2013; 38(3):436-41.
23. Mozes O, Guranda L, Portnoy O, Apter S, Konen E, Amitai MM. Radiographic features of intracorporeally smuggled liquid cocaine. Forensic Sci Med Pathol. 2014; 10(4):535-42.
24. Kundel HL, Polansky M. Measurement of observer agreement. Radiology. 2003;228(2):303-308.
25. Mehrpour O, Sezavar SV. Diagnostic imaging in body packers. Mayo Clin Proc. 2012; 87(7):e53-4.
26. Fareed A, Stout S, Casarella J, Vayalapalli S, Cox J, Drexler K. Illicit opioid intoxication: diagnosis and treatment. Subst Abuse. 2011; 5:17-25.
27. Hierholzer J, Cordes M, Tantow H, Keske U, Mäurer J, Felix R. Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound. Abdom Imaging. 1995; 20(4):333-38.
28. Sica G, Guida F, Bocchini G, Iaselli F, Iadevito I, Scaglione M. Imaging of drug smuggling by body packing. Semin Ultrasound CT MR. 2015; 36(1):39-47.
29. Poletti PA, Canel L, Becker CD, et al. Screening of illegal intracorporeal containers ("body packing"): is abdominal radiography sufficiently accurate? A comparative study with low-dose CT. Radiology. 2012; 265(3):772-79.
30. Sohail S. CT scan of body packers: findings and costs. J Pak Med Assoc. 2007;57(8):400-403.
31. Reginelli A, Russo A, Urraro F, et al. Imaging of body packing: errors and medico-legal issues. Abdom Imaging. 2015; 40(7):2127-42.