What is the role of radiography in the evaluation of body packing in cocaine toxicity?

Updated: Sep 01, 2018
  • Author: Lynn Barkley Burnett, MD, EdD, LLB(c); Chief Editor: Sage W Wiener, MD  more...
  • Print
Answer

Swallowed packets of cocaine may rupture, resulting in acute cocaine poisoning. They may also critically obstruct the esophagus or small bowel, typically at the ileocecal valve, or may cause bowel ischemia. Drug packets typically weigh 1-12 g each.

Begin with plain images of the abdomen to search for packets. However, the rate of false-negative results is 1.2-33%. Radiographs depicting packets are shown below.

Patient transporting cocaine packets seen on KUB a Patient transporting cocaine packets seen on KUB and lateral radiographs (mostly on left side). The patient was admitted, and a large number of packets was later obtained without procedural intervention or complication.
Patient transporting cocaine packets seen on KUB a Patient transporting cocaine packets seen on KUB and lateral radiographs (mostly on left side). The patient was admitted, and a large number of packets was later obtained without procedural intervention or complication.

Results from ultrasonography are occasionally useful for identifying packets, but not sensitive enough to exclude their presence. Contrast-enhanced study of the bowel or abdominal CT may be the only way of identifying the packages. This is shown in the image below.

CT scan of patient transporting cocaine packets. CT scan of patient transporting cocaine packets.

Regular radiologic examination is imperative to confirm successful transit of packages through the GI tract.

McCarron and Wood reported a series of 75 patients with suspected cocaine body packing evaluated with kidneys, ureters, and bladder (KUB) radiography. Cocaine packages (15-175 per individual) were retrieved from 48 patients. In 73%, the KUB images showed foreign bodies. KUB findings were negative in 3% of patients with cocaine packages in the rectum and in another 16% who subsequently passed 15-135 packages. [40]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!