Management recommendations for body stuffers at emergency units

  • Hossein Hassanian-Moghaddam
  • Fatemeh Amraei
  • Nasim Zamani Loghman Hakim Hospital, Shahid Behehsti University of Medical Sciences, Tehran
Keywords: body smuggling, conservative therapy, substances of abuse, surgery, toxicity


Managing body packers and stuffers is a challenge to emergency physicians, stuffers in particular, as there is no systematic approach to their treatment. The aim of this study was therefore to review all available literature on body stuffing and propose a guide to manage these patients. We searched Medline/PubMed, Google Scholar, and Scopus for published work on body stuffers using key words "body stuffer", "body stuffing", "poisoning", "toxicity", and "treatment" without a time limit and retrieved 290 articles, of which 61 remained after exclusion of those on "body packers" and repetitive documents. This review article evaluates and summarises the information gathered from them. The main step in body stuffer management is observation to make sure that they have passed all the swallowed packages of drugs of abuse. In some cases, imaging can be quite useful. Diagnostic pitfalls may be avoided with abdominopelvic CT without contrast, which is probably the best diagnostic method to determine the presence and the number of packages in these patients. Treatment should be specific for each group of drugs, whether it is opioids, cocaine, or amphetamine. Surgical interventions are indicated for obstruction of the intestines or package rupture. Legal precautions should be taken because of the legal complexity of body stuffing cases.


Deitel M, Syed AK. Intestinal obstruction by an unusual foreign body. Can Med Assoc J 1973;109: 211–2. PMCID: PMC1946817

MSD Manual. Body packing and body stuffing. Available at:

Booker RJ, Smith JE, Rodger MP. Packers, pushers and stuffers-managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J 2009;26: 316–20. doi: 10.1136/emj.2008.057695

Raben AM, Phoa SSKJ, Busch OR, Schultz MJ. Case report of a smuggler’s dinner: carrots and asparagus, or bolitas? Med Sci Monit 2005;11:CS79–81. PMID: 16319794

United Nations Office of Drugs and Crimes. 2005 World Drug Report [displayed 30 May 2019]. Available at

Traub SJ, Hoffman RS, Nelson LS. Body packing – the internal concealment of illicit drugs. N Engl J Med 2003;349:2519–26. doi: 10.1056/NEJMra022719

Taheri MS, Hassanian-Moghaddam H, Birang S, Hemadi H, Shahnazi M, Jalali AH, Shakiba M, Nahvi V. Swallowed opium packets: CT diagnosis. Abdom Imaging 2008;33:262–6. doi: 10.1007/s00261-007-9269-2

Bulakci M, Cengel F. The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools'. Br J Radiol 2016;89:20150888. doi: 10.1259/bjr.20150888

Simson LR Jr. Sudden death while attempting to conceal illegal drugs: laryngeal obstruction by a package of heroin. J Forensic Sci 1976;21:378–80. PMID: 1262836

Roberts JR, Price D, Goldfrank L, Hartnett L. The body stuffer syndrome: a clandestine form of drug overdose. Am J Emerg Med 1986;4:24. PMID: 3947429

Cunningham N. Medicolegal issues surrounding body packers, pushers and stuffers. Emerg Med Australas 2012;24:590–4. doi: 10.1111/1742-6723.12001

June R, Aks SE, Keys N, Wahl M. Medical outcome of cocaine bodystuffers. J Emerg Med 2000;18:221–4. doi: 10.1016/S0736-4679(99)00198-5

Sporer KA, Fireston J. Clinical course of crack cocaine body stuffers. Ann Emerg Med 1997;29:596–601. doi: 10.1016/S0196-0644(97)70246-4

Philip R, Aidayanti D. Uncommon sites for body stuffing: a literature review. Br J Med Med Res 2014;4:1943–9. doi: 10.9734/BJMMR/2014/7683

Erfantalab P, Zamani N, Hashemi-Domeneh B, Hassanian-Moghaddam H, Akhgri M. Abdominal computed tomography of a fatal amphetamine poisoning; pitfalls of diagnosis and treatment. Zahedan J Res Med Sci 2016;18:e2853. doi: 10.17795/zjrms-2853

Schaper A, Hofmann R, Bargain P, Desel H, Ebbecke M, Langer C. Surgical treatment in cocaine body packers and body pushers. Int J Colorectal Dis 2007;22:1531–5. doi: 10.1007/s00384-007-0324-9

Fineschi V, Centini F, Monciotti F, Turillazzi E. The cocaine “body stuffer” syndrome: a fatal case. Forensic Sci Int 2002;126:7–10. doi: 10.1016/S0379-0738(02)00011-7

West PL, McKeown NJ, Hendrickson RG. Methamphetamine body stuffers: an observational case series. Ann Emerg Med 2010;55:190–7. doi: 10.1016/j.annemergmed.2009.08.005

Heymann-Maier L, Trueb L, Schmidt S, Carron PN, Hugli O, Heymann E, Yersin B. Emergency department management of body packers and body stuffers. Swiss Med Wkly. 2017 Sep 12;147:w14499. doi: 10.4414/smw.2017.14499.

Aks SE, Vander Hoek TL, Hryhorczuk DO, Negrusz A, Tebbett I. Cocaine liberation from body packets in an in vitro model. Ann Emerg Med 1992;21:1321–5. doi: 10.1016/S0196-0644(05)81895-5.

Püschel K, Stein S, Stobbe S, Heinemann A. Analysis of 683 drug packages seized from "body stuffers". Forensic Sci Int 2004;140:109–11. doi: 10.1016/j.forsciint.2003.10.025

Norfolk GA. The fatal case of a cocaine body-stufer and a literature review – towards evidence based management. J Forensic Leg Med 2007;14:49–52. doi: 10.1016/j.jcfm.2005.12.002

Hassanian-Moghaddam H, Abolmasoumi Z. Consequence of body packing of illicit drugs. Arch Iran Med 2007;10:20–3. doi: 07101/AIM.006

de Beer SA, Spiessens G, Mol W, Fa-Si-Oen PR. Surgery for body packing in the Caribbean: a retrospective study of 70 patients. World J Surg 2008;32:281–5. doi: 10.1007/s00268-007-9316-8

Silverberg D, Menes T, Kim U. Surgery for "body packers": a 15-year experience. World J Surg 2006;30:541–6. doi: 10.1007/s00268-005-0429-7

Heinemann A, Miyaishi S, Iwersen S, Schmoldt A, Püschel K. Body-packing as cause of unexpected sudden death. Forensic Sci Int 1998;92:1–10. doi: 10.1016/S0379-0738(97)00192-8

Traub SJ. Internal concealment of drugs of abuse (body packing). UpToDate 2008 [displayed 30 May 2019]. Available at

Merigian KS, Park LJ, Leeper KV, Browning RG, Giometi R. Adrenergic crisis from crack cocaine ingestion: report of five cases. J Emerg Med 1994;12:485–90. doi: 10.1016/0736-4679(94)90345-X

Jordan MT, Bryant SM, Aks SE, Wahl M. A five-year review of the medical outcome of heroin body stuffers. J Emerg Med 2009;36:250. doi: 10.1016/j.jemermed.2007.06.022

Riggs D, Weibley RE. Acute toxicity from oral ingestion of crack cocaine: a report of four cases. Pediatr Emerg Care 1990;6:24–6. PMID: 2320483

Eng JG, Aks SE, Waldron R, Marcus C, Issleib S. False-negative abdominal CT scan in a cocaine body stuffer. Am J Emerg Med 1999;17:702–4. doi: 10.1016/S0735-6757(99)90166-3

Yamamoto T, Malavasi E, Archer JR, Dargan PI, Wood DM. Management of body stuffers presenting to the emergency department. Eur J Emerg Med 2016;23:425–9. doi: 10.1097/MEJ.0000000000000277

Moreira M, Buchanan J, Heard K. Validation of a 6-hour observation period for cocaine body stuffers. Am J Emerg Med 2011;29:299–303. doi: 10.1016/j.ajem.2009.11.022

Hierholzer J, Cordes M, Tantow H, Keske U, Mäurer J, Felix R. Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound. Abdom Imaging 1995;20:333–8. doi: 10.1007/BF00203366

Buchanan J, Moreira M, Heard K. Response to Letter to the Editor: validation of a 6-hour observation period for cocaine body stuffers. Am J Emerg Med 2011;29:471–2. doi: 10.1016/j.ajem.2011.01.015

Ab Hamid S, Abd Rashid SN, Mohd Saini S. Characteristic imaging features of body packers: a pictorial essay. Jpn J Radiol 2012;30:386–92. doi: 10.1007/s11604-012-0069-4

Sica G, Guida F, Bocchini G, Iaselli F, Iadevito I, Scaglione M. Imaging of drug smuggling by body packing. Semin Ultrasound CT MR 2015;36:39–47. doi: 10.1053/j.sult.2014.10.003

Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, Romano L, Brunese L. Radiological and practical aspects of body packing. Br J Radiol 2014;87:20130500. doi: 10.1259/bjr.20130500

Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M. Body packing: a review of general background, clinical and imaging aspects. Radiol Med 2015;120:118–32. doi: 10.1007/s11547-014-0458-0

Booker RJ, Smith JE, Rodger MP. Packers, pushers and stuffers-managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J 2009;26:316–20. doi: 10.1136/emj.2008.057695

Hergan K, Kofler K, Oser W. Drug smuggling by body packing: what radiologists should know about it. Eur Radiol 2004;14:736–42. doi: 10.1007/s00330-003-2091-5

Algra PR, Brogdon BG, Marugg RC. Role of radiology in a national initiative to interdict drug smuggling: the Dutch experience. AJR Am J Roentgenol 2007;189:331–6. doi: 10.2214/AJR.07.2306

Karhunen PJ, Suoranta H, Penttilä A, Pitkäranta P. Pitfalls in the diagnosis of drug smuggler’s abdomen. J Forensic Sci 1991;36:397–402. doi: 10.1520/JFS13042J

Marc B, Baud FJ, Aelion MJ, Gherardi R, Diamant-Berger O, Blery M, Bismuth C. The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci 1990;35:345–55. doi: 10.1520/JFS12835J

Hoffman RS, Chiang WK, Weisman RS, Goldfrank LR. Prospective evaluation of "crack-vial" ingestions. Vet Hum Toxicol 1990;32:164–7. doi: 10.1016/S0196-0644(05)82442-4

Alzen G, Banning S, Gunther R. Experimentelle Untersuchung beim HundSonographic identification of drug containers in the gastrointestinal tract – Experimental study in the dog [Sonographic detectability of narcotic drug containers in the gastrointestinal tract. Experimental research in the dog, in German]. Rofo 1987;146:544–7. doi: 10.1055/s-2008-1048536

Meijer R, Bots ML. Detection of intestinal drug containers by ultrasound scanning: an airport screening tool? Eur Radiol 2003;13:1312–5. doi: 10.1007/s00330-002-1689-3

Cengel F, Bulakci M, Selcuk T, Savas Y, Ceyhan M, Kocak A, Bilgili CO. The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study. Abdom Imaging 2015;40:2143–51. doi: 10.1007/s00261-015-0430-z

Beerman R, Nunez D Jr, Wetli CV. Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol 1986;11:351–4. doi: 10.1007/BF02035108

Shahnazi M, Hassanian-Moghaddam H, Gachkar L, Ahmadi N, Zamani N, Bahrami-Motlagh H, Faghihi Langroudi T, Arjmand Shabestari A, Mohammad Alizadeh A. Comparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers. Clin Toxicol (Phila) 2015;53:596–603. doi: 10.3109/15563650.2015.1054501

Bahrami-Motlagh H, Mahboubi-Fooladi Z, Salevatipour B, Hassanian-Moghaddam H, Mirhashemi SH. Comparison of low dose and standard dose abdominal CT scan in body stuffers. Clin Toxicol (Phila) 2018;56:348–54. doi: 10.1080/15563650.2017.1377220

Bahrami-Motlagh H, Hassanian-Moghaddam H, Zamini H, Zamani N, Gachkar L. Correlation of abdominopelvic computed tomography with clinical manifestations in methamphetamine body stuffers. Radiol Med 2018;123:98–104. doi: 10.1007/s11547-017-0818-7

Tomaszewski C, Voorhees S, Wathen J, Brent J, Kulig K. Cocaine adsorption to activated charcoal in vitro. J Emerg Med 1992;10:59–62. doi: 10.1016/0736-4679(92)90012-I

Hoffman RS, Smilkstein MJ, Goldfrank LR. Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem. Am J Emerg Med 1990;8:523–7. doi: 10.1016/0735-6757(90)90155-S

Cumpston KL, Aks SE, Sigg T, Pallasch E. Whole bowel irrigation and the hemodynamically unstable calcium channel blocker overdose: primum non nocere. J Emerg Med 2010;38:171–4. doi: 10.1016/j.jemermed.2007.11.100

Thanacoody R, Caravati M, Troutman B, Höjer J, Benson B, Hoppu K, Erdman A, Bedry R, Mégarbane B. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2015;53:5–12. doi: 10.3109/15563650.2014.989326

Shabani M, Zamani N, Hassanian-Moghaddam H. Endoscopic retrieval of baggies in body stuffers. Endosc Int Open 2016;4(4):E443–5. doi: 10.1055/s-0042-103242

Stolbach A, Hoffman RS. Acute opioid intoxication in adults [displayed 6 May 2019]. Available at

Nelson L, Odujebe O. Cocaine: Acute intoxication [displayed 6 May 2019]. Available at

Bahrami-Motlagh H, Hassanian-Moghaddam H, Behnam B, Arab-Ahmadi M. Failure of surgical treatment in methamphetamine body-stuffers. J Forensic Leg Med 2015;32:70–2. doi: 10.1016/j.jflm.2015.03.001

Aks E, Bryant SM. Acute ingestion of illicit drugs (body stuffing) [displayed 6 May 2019]. Available at

How to Cite
Hassanian-MoghaddamH, Amraei F, Zamani N. Management recommendations for body stuffers at emergency units. Arh Hig Rada Toksikol [Internet]. 2019May21 [cited 2020Dec.2];70(2). Available from:

Most read articles by the same author(s)