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A man with drowsiness and abdominal pain

Q1: What is the diagnosis?
The diagnosis is heroin overdose because of the inadvertent rupture of packages after body packing or body smuggling.

Q2: What are the radiological abnormalities seen?
Radiography of the abdomen shows multiple rectangular shaped foreign bodies with air trapped at both ends. This finding in a patient where illicit drug overdose is suspected suggests body packing; this was confirmed by computed tomography. The advantage of this modality was that we were able to count the number of packages and determine the segments of gastrointestinal tract in which they were present. The apparent inability to see most of the packages on plain radiography suggests that it is easy to miss this diagnosis if only radiographs are relied upon.

Q3: What are the management options?
Conservative management includes careful observation, continuous whole bowel irrigation with polyethylene glycol (15–20 ml/kg/hour), and use of laxatives. It is generally accepted that absolute surgical indications are: suspicion of leak, obstruction in the proximal digestive tract, persistent intestinal obstruction, and lack . . . [Full text of this article]

Relevant Article

A man with drowsiness and abdominal pain

M Krishnamurthy, R V Desai, and H Patel
Postgrad. Med. J. 2004 80: 555. [Extract] [Full Text] [PDF]