Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules).
BACKGROUND
'Mules' or body packers are people who transport illegal drugs by packet ingestion into the gastrointestinal tract. These people are otherwise healthy and their management should maintain minimal morbidity. In this study, experience with body packers is presented and an algorithm for conservative and surgical management is provided.


METHODS
The clinical patient database for all body packer admissions at Mary Immaculate Hospital of the Caritas Health Care Inc. from 1993 to 2005 was interrogated. 56 patients (4.5%) required admission out of a total of 1250 subjects confirmed to be body packers and apprehended by United State Customs officials at JFK International Airport, New York. The retrieved patient data were analysed retrospectively.


RESULTS
70% of the body packers were men, with a male to female ratio of 2.8 to 1. The mean age was 33 years and 52% were from Columbia. Heroin was the most common illegally transported substance (73%). 25 patients (45%) required surgical intervention, whereas 31 patients (55%) were successfully managed conservatively. Indications for intervention included: bowel obstruction, packet rupture/toxicity, and delayed progression of packet transit on conservative management. Multiple intraoperative manoeuvres were used to remove the foreign bodies: gastrotomy, enterotomy and colotomy. Wound infection was the most common complication and is associated with distal enterotomy and colotomy.


CONCLUSIONS
Men were more likely to present as body packers than women. Proximal enterotomies are preferred and multiple enterotomies should be avoided. A confirmatory radiological study is needed to demonstrate complete clearance of packets. A systematic protocol for the management of body packers results in minimal morbidity and no mortality.
Department of Surgery, Caritas Health Care, New York Medical College-Brooklyn and Queens Program, New York, USA. drnmandava@gmail.com
Nageswara
N
Mandava
Richard S
RS
Chang
John H
JH
Wang
Michael
M
Bertocchi
Jonathan
J
Yrad
Shyam
S
Allamaneni
Edouard
E
Aboian
Malini H
MH
Lall
Rosalind
R
Mariano
Neil
N
Richards
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002985:Clinical Protocols; D003042:Cocaine / Q000009:adverse effects; D003415:Crime; D004349:Drug Packaging; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003932:Heroin / Q000009:adverse effects; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D012189:Retrospective Studies; D014186:Transportation; D055815:Young Adult
D013287:Illicit Drugs; D003932:Heroin; D003042:Cocaine