‘Mules’ or body packers are people who transport illegal drugs by packet ingestion into the gastrointestinal tract. A large study of body packers apprehended by United State Customs officials at JFK International Airport, New York describes experience with body packers and an algorithm for conservative and surgical management.
Of 56 patients requiring admission out of a total of 1250 subjects confirmed to be body packers, 25 patients (45%) required surgical intervention, whereas 31 patients (55%) were successfully managed conservatively.
Diagnosis:
- Plain abdominal x-ray was diagnostic in 49 patients (88% of all hospitalised patients).
- Non-contrast CT of the abdomen and pelvis is required if AXR is negative
- Forty-eight per cent of body packers had positive urine toxicology for illicit substances.
Management:
- Indications for intervention included:
- bowel obstruction
- packet rupture/toxicity
- delayed progression of packet transit on conservative management.
- Patients with packets found predominantly in the proximal gastrointestinal tract failed conservative management more frequently than those with packets found in the distal gastrointestinal tract.
Multiple intraoperative manoeuvres were used to remove the foreign bodies:
- gastrotomy
- enterotomy
- colotomy.
Wound infection was the most common complication and is associated with distal enterotomy and colotomy.
The authors recommend a confirmatory radiological study to demonstrate complete clearance of packets
Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules).
Emerg Med J 2011;28:98-10
