title: Surgical treatment in cocaine body packers and body pushers.
abstract: OBJECTIVE
  Body packers smuggle cocaine by swallowing containers filled with the drugs, whilst body pushers conceal the containers in the rectum or vagina. In a collaborative effort between the Department of General Surgery, two major airports and Poisons Centre, we performed a retrospective study to develop an algorithm for the treatment of ruptured cocaine-filled containers.
  
  
  METHODS
  The data of all cocaine body packers and body pushers who were identified at the airports of Frankfurt and Paris from 1985 to 2002 were evaluated concerning incidence, demographics and surgical aspects.
  
  
  RESULTS
  From 1985 to 2002, 312 body pushers and 4,660 body packers were identified. The sex ratio was 1:1. Sixty-four "mules" (1.4%) developed life-threatening symptoms of cocaine overdose after the rupture of a container. In 20 patients, an emergency laparotomy was performed and the containers were removed; all of these patients survived. Forty-four body packers died before surgical treatment could be performed. Only one body pusher required medical attention.
  
  
  CONCLUSIONS
  Cocaine overdose can be life-threatening. If the cause is the rupture of a container in a body packer, the only possible treatment is immediate laparotomy for the removal of the container.
authors.affiliation: GIZ-Nord Poisons Centre, (Giftinformationszentrum-Nord der Länder Bremen, Hamburg, Niedersachsen und Schleswig-Holstein), Zentrum Pharmakologie und Toxikologie, Georg August University, University Hospital, Göttingen, Germany. aschaper@giz-nord.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Schaper
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann
authors.forename: Philippe
authors.initials: P
authors.lastname: Bargain
authors.forename: Herbert
authors.initials: H
authors.lastname: Desel
authors.forename: Martin
authors.initials: M
authors.lastname: Ebbecke
authors.forename: Claus
authors.initials: C
authors.lastname: Langer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D003042:Cocaine / Q000506:poisoning*; D062787:Drug Overdose / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005858:Germany; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010297:Paris; D017410:Practice Guidelines as Topic; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D003042:Cocaine