title: [Surgical complications in drug body-packers: an uncommon but potentially lethal emergency].
abstract: BACKGROUND
  Drug trafficking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the port of entry to Europe for drugs, and some Spanish hospitals have experience in managing these types of patients. Two hospitals in Madrid, including the Gregorio Marañón University General Hospital (HGUGM), received these potential patients from the Madrid Barajas airport.
  
  
  OBJECTIVE
  To analyse the results of the conservative treatment and the need for surgery in "body-packers".
  
  
  METHODS
  A retrospective, observational study of patients diagnosed as a body-packer between January 2000 and December 2008. Those with gastrointestinal symptoms, signs of poisoning, or positive for drugs of abuse, were admitted to the Custodial Unit of our hospital. The conservative treatment consisted of digestive rest and imaging studies until expulsion from the body. Asymptomatic patients were discharged from the Emergency Department.
  
  
  RESULTS
  A total of 549 patients, with a median age of 31 years, and of whom 81% were males, were hospitalised during this period. Less than half (40%) showed positive for drugs in the urine, with cocaine in 80% of the cases. Of the 549 patients with initial conservative treatment, 27 (4.9%) had serious complications (16, bowel obstruction, and 11 with signs of poisoning). Of these, 23 required surgery (the 16 obstructions and 7 of the poisonings); 2 were successfully treated in ICU, and 2 died before surgery (0.4%) of the cases. The most frequent surgical treatment was enterotomy and/or gastrostomy to extract the packets. Thirteen (56%) of those operated on had associated morbidity (11 abdominal infections and 2 nosocomial infections).
  
  
  CONCLUSIONS
  Conservative treatment is safe in 95% of the patients. A small percentage required surgical treatment, basically for gastrointestinal obstruction or severe poisoning.
authors.affiliation: Servicio de Cirugía General II, Hospital General Universitario Gregorio Marañón, Madrid, España. lau_alvarez84@hotmail.com
authors.forename: Laura
authors.initials: L
authors.lastname: Álvarez Llano
authors.forename: Cristina
authors.initials: C
authors.lastname: Rey Valcárcel
authors.forename: Yusef
authors.initials: Y
authors.lastname: Mohamed Al-Lal
authors.forename: Teresa
authors.initials: T
authors.lastname: Sánchez Rodríguez
authors.forename: Andrés
authors.initials: A
authors.lastname: García Marín
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Pérez Díaz
authors.forename: Fernando
authors.initials: F
authors.lastname: Turégano Fuentes
mesh_terms: D000328:Adult; D064423:Drug Trafficking; D004630:Emergencies; D004638:Emergency Treatment; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000601:surgery*; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013030:Spain
chemical_list: D013287:Illicit Drugs