Clinical management of cocaine body packers: the Hillingdon experience

International smuggling of cocaine by internal concealment is a serious and growing problem. People who engage in this practice are commonly referred to as body packers or mules. The most serious risks associated with body packing include intestinal obstruction and death from cocaine intoxication. These patients were previously managed primarily by surgical retrieval. This was associated with significant mortality due to rupture of poorly constructed cocaine packages. More recently, conservative management using whole bowel irrigation with polyethylene-glycol (Klean-prep Norgine) has been shown to be safe for most patients. To date, however, a consistent approach for the management of these patients has not been established.

We retrospectively reviewed the case notes, prescription charts and radiological investigations of all body packers admitted to our unit between 2000 and 2005, concentrating on initial management, complications and outcome.

We identified 61 patients for inclusion. Of these, 56 were managed conservatively with a selection of aperients and laxatives. Six patients were treated successfully for cocaine toxicity and 5 required surgical retrieval of cocaine packets.

Our results confirm the safety of a conservative approach. Based on our experience and a review of the literature, we have devised a treatment protocol to reduce the risk of complications and the length of stay in hospital.