Comparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers

Abstract

Context. Toxicity due to body packing/pushing/stuffing is a major concern in many countries. Of different imaging techniques, computed tomography (CT) scan is described as the method of choice in detecting body couriers, but there is no study to concomitantly compare with- and without-contrast abdominopelvic CTs to determine the more accurate one for this purpose.Objective. We aimed to evaluate the efficacy of abdominopelvic CT “with” and “without” oral contrast in diagnosis of existence, number, and type of packets in body packers/pushers and stuffers. Materials and methods. In a prospective observational case series, all suspected cases of body packing/stuffing were included and underwent abdominopelvic CT with and without oral contrast in a one-year period. CT scans were reported by three independent attending radiologists blind to the demographic and clinical results and compared to our defined “gold standard” which was surgery or expulsion of packets. The existence and number of packets detected by each method were compared to define the better method of diagnosis. Results. Of 11 suspect body packers/pushers, 10 carried packs. Abdominopelvic CT with and without oral contrast detected six and seven of them, respectively. In 24 body stuffers, CT without oral contrast was more accurate in diagnosis of existence (9/24 vs. 7/24, p = 0.003) and number (sensitivity and positive predictive values of 29.2% vs. 37.5% and 100% vs. 100% for CTs with and without oral contrast, respectively, p = 0.021). Discussion and conclusions. There is a remarkable gap between detection of existence and number of packets/baggies reported by the radiologists and the real condition of the patients. A close teamwork between radiologists and toxicologists is needed to manage these problematic cases.

Keywords:

• Body packer
• Body pusher
• Body stuffer
• CT scan with and without oral contrast
• Poisoning
• Drug trafficking

Acknowledgment

This research was supported by Loghman-Hakim Clinical Research Development Center at Shahid-Beheshti University of Medical Sciences (Grant no. 117-6993). The authors thank the personnel of radiology department and nurses of Medical Toxicology Complex for their assistance with data collection.

Declaration of interest

The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.