Body packing in the emergency department: a pictorial essay with common imaging findings

Body packing, a method used to traffic illicit drugs, primarily involves the gastrointestinal tract as a concealment route. Commonly trafficked substances include cocaine, heroin, marijuana, methamphetamine, and cannabis, often sealed in handmade latex packets characterized by specific imaging signs. Prompt diagnosis is crucial for initiating appropriate treatment, recognizing complications, and ensuring proper medico-legal handling. Abdominal radiographs are the preferred initial imaging modality due to their low cost and widespread availability, though their sensitivity varies depending on packet size, location, and interpreter expertise. Abdominopelvic non-contrast CT is the gold standard for detecting gastrointestinal packages, offering high sensitivity and specificity. Low-dose CT protocols are recommended to minimize radiation exposure without compromising diagnostic accuracy, particularly for follow-up or in cases without complications. Contrast-enhanced CT is reserved for assessing suspected complications such as bowel obstruction or perforation. This pictorial review highlights key imaging findings correlated with clinical features, aiming to facilitate accurate recognition, timely intervention, and prevention of complications in suspected cases.