title: Oesophageal and gastric obstruction in a cocaine body packer.
abstract: While the management of asymptomatic body packers is mainly conservative, few individuals will require surgery for acute toxicity related to packets rupture, intestinal obstruction or very slow progression of the packages. Obstruction of the lower oesophagus or stomach is not frequently reported. We report the case of a 49-year-old woman who had ingested 92 cocaine-containing packages. She was admitted to the hospital after opioid syndrome related to the intake of morphine and codeine to decrease intestinal transit. The presence of more than 80 packages was suspected in the stomach on the initial abdomen computed tomography. Due to the absence of progression of the packages after four days of well-conducted laxative therapy and to major gastric distension at abdomen tomography, surgery was decided and gastrotomy allowed the evacuation of 80 packages that were still present in the stomach or in the lower oesophagus. In addition, 12 other packages had been retrieved either after laxative therapy (9) or by evacuation via the anal canal (3) after palpation of the intestine during the surgical procedure. No complication was observed.
authors.affiliation: Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium; Louvain Centre for Toxicology and Applied Pharmacology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium. Electronic address: philippe.hantson@uclouvain.be.
authors.forename: P
authors.initials: P
authors.lastname: Hantson
authors.affiliation: Louvain Centre for Toxicology and Applied Pharmacology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Capron
authors.affiliation: Department of Abdominal Surgery, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: J-F
authors.initials: JF
authors.lastname: Maillart
mesh_terms: D003042:Cocaine; D003415:Crime; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics; D011859:Radiography
chemical_list: D054368:Laxatives; D009294:Narcotics; D003042:Cocaine
keywords: Body packing; Cocaine; Endoscopy; Gastrointestinal obstruction; Surgery