DESCRIPTION

The figure shows 30 of 89 packets of cocaine surgically removed from the stomach and bowel of a patient apprehended for the internal concealment of drugs (“body-packers” or “mules”). The individual was observed to be behaving in an agitated and disorientated manner on disembarking an aircraft. Clinically he was sweating profusely, hypertensive (234/140 mmHg) and tachycardic at 140 beats/min. Urinalysis was subsequently positive for cocaine and an abdominal radiograph showed numerous well defined packets throughout the gastrointestinal tract. Some packets (oblique white arrow in fig 1) appear to have lost some content.

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Figure 1

Packets of cocaine surgically removed from a “body packer”. The white arrow indicates a package that appears to have lost some content and hence may have ruptured.

Cocaine affects the cardiovascular system through an increase in heart rate and blood pressure and profound vasoconstriction. The resultant ischaemia may cause angina, myocardial infarction, sudden arrhythmic cardiac death, pulmonary oedema and less well appreciated stroke (the majority are haemorrhagic) and aortic dissection. Our patient survived and left hospital 10 days after surgery.

Cocaine is the most frequently smuggled drug by this method and at London Heathrow airport about five to eight individuals a week are detected. Each individual packet contains a potentially fatal dose (1–3 mg) of cocaine.1 The majority of body-packers who suffer packet rupture will die before reaching hospital. Many are found collapsed or dead in hotel rooms, surrounded by purges and enemas.2 This practice is driven by an estimated street value of £50 000–100 000 (depending on purity), from this cache alone.

The treatment of cocaine poisoning from packet rupture is immediate medical stabilisation and urgent surgical intervention.