"Body stuffing" and "Body packing" - Forensic control of human excrements in police custody in Hamburg, Germany.

INTRODUCTION: Different methods are used to confiscate evidence whenever suspected body packers or body stuffers are taken into custody. Among these, controlled defecation and analysis of drug toilets from suspects has proved to be safe given that no invasive or forceful procedures are applied. MATERIALS AND METHODS: All records of "drug toilet" evaluations done at the Hamburg Institute of Legal Medicine from January 1st 2018 to April 30th 2021 were descriptively analyzed for the individual's age, sex, country of origin, and whether the drug toilets contained any drug "balls", packages or containers. In case of a positive finding, the total number of balls found were recorded. Special cases are presented in detail for illustrative purposes. RESULTS: Drug toilets from 72 suspects were examined in the period under review. 98.6% (n = 71) of the suspects were males and relatively young with approximately two-thirds (62.5%, n = 45) aged 34 years or below (range 18-50 years). The majority of suspects originated from African countries (72.2%, n = 52). The typical drug balls or containers were found in 13 (18.1%) of the examined drug toilets. CONCLUSION: Negative drug toilets might indeed indicate that the suspect had not ingested any drug packages at the time of arrest or while in custody. However, multiple excretions, voluntary delay of defecation, use of drugs to delay the excretion process or even individual differences in excretion times are possible, and therefore, a negative drug toilet should not always imply with certainty that the individual in question had not ingested any drugs.

Body-Packing: A Rare Diagnosis to Keep in Mind.

Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages. LEARNING POINTS: Body packing is a potentially lethal activity.Body-packers can be asymptomatic, or have signs/symptoms of systemic drug toxicity or gastrointestinal obstruction or perforation.It is essential to recognize this condition so that the correct clinical approach, diagnosis and management can be established.

Contribution of dual-energy computed tomography in the differentiation of illicit drugs.

INTRODUCTION: The objective of this study was to compare the dual-energy behaviour of the main illicit substances as well as their cutting agents in order to be able to differentiate them. MATERIAL AND METHODS: Cocaine, heroin, MDMA, and cannabis as well as 3 adulterants, 2 diluents, and water were scanned at 90 kV and then at 140 kV on a single X-ray tube computed tomography (CT) scanner. The data acquired enabled a mapping of the attenuation values to 90 and 140 kVp as well as a resulting dual-energy index (DEI) mapping. RESULTS: Drugs, cocaine, MDMA (pill), and cannabis had a positive DEI (0.014-0.008), while heroin and MDMA (powder) had a negative DEI (-0.016 and -0.013). The DEI of water was -0.01 and that of taurine was -0.018. Adulterants had negative DEI, while diluents had a positive DEI. All DEI were significantly different (p < 0.01). CONCLUSIONS: Cocaine and heroin can be clearly differentiated using DEI.

Case Report: Don't chew the fufu: a case report of suspected drug body stuffing.

Background: Intrabody concealment of illicit substances is a common practice in the trafficking chain. Bodystuffing, which consists of precipitously swallowing packets of substances for concealment from law-enforcement officers in anticipation of impending search or arrest, is particularly dangerous. There is a risk of rupture of the loosely wrapped drug packets, which could lead to substance intoxication or even death. Case presentation:  This article reports the case of a young man who was taken by law enforcement authorities to our Emergency Department for investigation of bodystuffing. Although the patient denied the facts, the initial reading of the computed tomography (CT) scan confirmed the presence of multiple images compatible with drug packets, which were mostly in the stomach. Upon admission to our secured inpatient ward for clinical surveillance of packet evacuation, the patient denied again having ingested such packets, and declared that he only ate 'fufu'. Fufu is a traditional food of central and western Africa consisting of a starchy preparation compacted by hand into small balls. Fufu balls are usually swallowed without chewing to allow a sensation of stomach fullness throughout the day. Considering the fufu intake history, a careful reassessment of the imaging confirmed the presence of food content. Conclusions: This case study offers an example of bodystuffing false positive due to fufu. It illustrates the importance of a history of food intake that could bias the interpretation of CT scan images.

Cannabis body packing: a case report.

Drug traffic is a major concern worldwide. We report a case of a 27-year old male who presented with a diffuse abdominal plain to the emergency department. Abdominal X-ray demonstrated multiple foreign bodies along the intestinal tract, which were found to be cannabis packets. The patient was treated conservatively with a good result.

A body-packer with a cocaine bag stuck in the stomach.

Management of patients carrying packets of drugs in the digestive tract is a frequent medical problem. We report on a patient who was referred by the police after ingestion of packets of cocaine. After spontaneous elimination of 81 drug packets, the patient had three unremarkable stools. A plain abdominal X-ray disclosed no residual packet but computed tomography (CT) scan showed one in the stomach. As this was not eliminated during the 10 d following ingestion, it was removed through gastrotomy. This case stresses the usefulness of the CT scan to ensure that no residual packet is present before hospital discharge.