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Three Part Question

In [patients suspected of internal drug carriage ('Body-Packers', 'Body-Stuffers')] is [plain abdominal radiography] of [diagnostic utility]?

Clinical Scenario

A 26 year old male in custody is brought to the emergency department with abdominal pain. He claims to have ingested a large amount of 'drug-filled packages'. He is tachycardic. Examination is otherwise normal. You wonder if plain abdominal x-ray is indicated.

Search Strategy

Medline 1966-03/04 using the Ovid interface.
[(Exp Radiography, Abdominal OR abdominal radiography.mp OR abdominal x-ray.mp OR plain abdominal x-ray.mp OR plain film abdomen.mp) AND (body packers.mp OR body stuffers.mp OR body pack$.mp OR body stuff$.mp)] LIMIT to Human AND English.

Search Outcome

Altogether 12 papers were found of which 2 were relevant to the topic of interest.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Karhunen PJ et al, 1992, Finland	82 patients suspected of internal drug carriage	Prospective observational series	Detection of internal drug packages using abdominal radiography	Sensitivity 90% Specificity 97%	Small numbers No blinding
Heirholzer J et al, 1995, Germany	12 patients suspected of internal drug carriage	Prospective observational series	Detection of internal drug packages using abdominal radiography and ultrasound	7 out of 12 cases detected	Small study Questionable gold standard applied

Comment(s)

The possibility of internal carriage of drugs is an increasingly frequent presentation to urban emergency departments. A diagnostic dilemma is usual owing to credibility of the presentation. It is important, therefore, that clinicians understand the utility of any investigations used. In particular the failure to appreciate the possibility of a false negative result might prove fatal.

Clinical Bottom Line

A single abdominal radiograph is insufficiently sensitive to rule-out abdominal drug carriage. However, specificity is high and a positive finding is diagnostic.

References

1. Karhunen PJ, Suoranta H, Penttila A, et al. Pitfalls in the diagnosis of drug smuggler's abdomen. J Forensic Sci 1991;36(2):397-402.
2. Hierholzer J, Cordes M, Tantow H, et al. Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound. Abdom Imaging 1995;20(4):333-8.