Tuğba Matlım ÖZEL, Oğuzhan AYTEPE, Sezer AKBULUT, Aykut ÇELİK, Görkem YILDIZ, Ali BEKRAKİ, Serkan SARI
İstanbul Medical Journal - 2026;27(1):7-12
Introduction: Body packing, the internal concealment of illicit drugs within the gastrointestinal tract, remains a significant public health and medicolegal concern. Advances in drug-packet manufacturing have reduced rupture rates but have not eliminated the risk of life-threatening complications, including acute toxicity, bowel obstruction, and perforation. Early detection and optimal management are critical to preventing morbidity and mortality. Methods: We conducted a retrospective observational study of patients admitted to the Department of Emergency, University of Health Sciences Türkiye, Çam and Sakura City Hospital, between June 2021 and July 2025 with confirmed body packing. The diagnosis was established by plain abdominal radiography (X-ray) and non-contrast abdominopelvic computed tomography (CT). Patients were classified into two groups: those managed conservatively and those requiring additional intervention (endoscopic or surgical). Demographic, clinical, laboratory, and imaging data were analyzed to identify predictors of conservative management failure. Results: Of 45 hospitalized patients, 36 met inclusion criteria. The majority were male (86%), and the mean age was 36.0+/-11.6 years. X-ray imaging detected packets in 88.9% of cases, whereas non-contrast CT detected them in 100% of cases. Conservative management was successful in 30 patients (83.3%). Six patients (16.7%) required intervention -three endoscopic and three surgical. The surgical intervention rate was 8.3%, with one intraoperative death (2.7%). Complication and toxicity rates were 16.7% and 8.3%, respectively. Predictors of intervention included fewer ingested packets (p=0.03), longer hospital stay (p=0.005), presence of symptoms (p=0.02), positive physical examination findings (p=0.01), and electrocardiography abnormalities (p=0.01). Conclusion: Non-contrast CT is the gold standard for detecting and quantifying drug packets in body packers, offering 100% diagnostic accuracy in this cohort. Conservative management is safe and effective in the majority of patients; however, close monitoring is essential in symptomatic patients, those with abnormal findings on physical examination, or those with prolonged ingestion-to-admission intervals. Surgical intervention should be reserved for cases with toxicity, bowel obstruction, or failed conservative management.
