Pharmacobezoar: a rare cause of body packing misdiagnosis

Abstract

Introduction

Diagnosis of body packing based on the misinterpretation of imaging is rare.

Case report

An unaccompanied 55-year-old woman presented with uncontrolled vomiting in the airport transit area. An abdominal radiograph and computed tomography scan revealed multiple radiopaque foreign bodies in the colon. History was unobtainable due to the language barrier. The patient was referred to our institution as a body packer who required surgical extraction of the packets. In the absence of symptoms, she was managed conservatively with antiemetic drugs and whole bowel irrigation. The final diagnosis was radiopaque pharmacobezoars caused by an over-the-counter barium-containing anticancer medication in the setting of severe hypokalemia-associated paralytic ileus following post-chemotherapy vomiting. After the correction of her potassium concentration, the patient was discharged and resumed her trip.

Conclusion

Clinicians should be warned that pharmacobezoars might be mistaken for drug packets on abdominal imaging leading to body packing misdiagnosis.

Keywords:

• Body packer
• pharmacobezoar
• imaging
• diagnosis
• barium

Acknowledgments

The authors would like to thank Dr Joel Poupon, Dr Romain Magny, Professor Pascal Houzé, and Dr Laurence Labat from the Laboratory of Toxicology, Lariboisière Hospital, for their help in the toxicological analysis of the capsules and blood samples.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.