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Bodypacking--an increasing problem in The Netherlands: conservative or surgical treatment?
A A W van Geloven1, K P van Lienden, D J Gouma
1Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. nvangeloven@zonnet.nl
Objective:
Evaluation of diagnostic work-up and treatment of bodypackers. Identification of predictive factors for surgical treatment.
Design:
Retrospective descriptive study.
Setting:
Teaching hospital, The Netherlands.
Patients:
All 40 consecutive patients, admitted during the period 1995-99 inclusive to the surgical department with the diagnosis of "bodypacker".
Main Outcome Measures:
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.
Conclusion:
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.