Contrast CT scan fails to detect the last heroin packet

We report on the comparative utility of the abdominal computed tomography (CT) scan and contrast-enhanced plain radiography in one case of a "body packer" who claimed to have passed 50 out of 55 packets before being brought to the Emergency Department by the police for further gastrointestinal decontamination. The presence of retained packets was confirmed by plain radiography. The patient received whole bowel irrigation (WBI) with polyethylene glycol electrolyte solution (PEG-ELS) and passed four more packets. A helical abdominal CT scan with oral contrast was performed to identify any residual packets. A negative CT scan and a reliable patient prompted a subsequent upright abdominal radiograph that showed the last packet in the right lower quadrant. This packet ultimately passed with continued WBI. This case illustrates the failure of CT scan to identify the last packet and suggests that multiple modalities may be necessary to fully confirm a therapeutic endpoint.