Bodypacking--an increasing problem in The Netherlands: conservative or surgical treatment?
OBJECTIVE
Evaluation of diagnostic work-up and treatment of bodypackers. Identification of predictive factors for surgical treatment.


METHODS
Retrospective descriptive study.


METHODS
Teaching hospital, The Netherlands.


METHODS
All 40 consecutive patients, admitted during the period 1995-99 inclusive to the surgical department with the diagnosis of "bodypacker".


METHODS
Age, sex, medical history, additional diagnostic investigation, treatment, morbidity, and mortality.


RESULTS
There were 36 men and 4 women, the reason for whose visit to the emergency department was the persistence of cocaine packages in the body. 24 had abdominal pain and 15 patients were vomiting. In all cases packages were identified on an abdominal radiograph taken supine. The cocaine concentration in the urine was raised in 8/13 patients. During admission 18/40 patients (45%) were operated on, and in 9 patients (23%) a previously unsuspected lesion was found, which was causing the obstruction. Factors predictive of the need for surgical treatment were: abdominal history (p = 0.01), abdominal pain while in the emergency department (p = 0.001), location of the packages of cocaine in the stomach and small intestine on the abdominal radiograph (p = 0.05), and a high concentration of cocaine in the urine (p = 0.03). 9 of the patients operated on developed complications; no patient died.


CONCLUSIONS
The number of bodypackers admitted to the surgical department increases. More than half the patients could be treated conservatively. Factors predictive of the need for surgery are: abdominal history, pain, high obstruction, and cocaine in the urine. In 9 of the patients operated on an unsuspected disease was found that was causing the obstruction.
van Geloven
A A W
AA
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. nvangeloven@zonnet.nl
van Lienden
K P
KP
Gouma
D J
DJ
D000005:Abdomen; D000328:Adult; D003042:Cocaine / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000592:standards / Q000639:trends; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy*
D003042:Cocaine