2 out of 5 stars
Assessment of the management outcomes of body packers. Alfa-Wali M et al. ANZ J Surg 2015 Jul 14 [Epub ahead of print]
This article from Hillingdon Hospital in London — located a mere 4 miles from Heathrow airport — was intended to evaluate the facility’s existing protocol for managing body packers.
Although some details of their protocol are not justified or even well-described, in general they align with the trend towards conservative treatment of asymptomatic patients, with observation bowel cleansing agents — they used Picolax (sodium picosulfate with magnesium citrate) or Klean-Prep (polyethylene glycol.) Surgery was reserved for patients showing signs of toxicity from cocaine or heroin, or gastrointestinal obstruction, but not done just because ingested packets had not passed within a pre-specified time period.
The study retrospectively reviewed charts of 120 patients referred to the hospital between 2000 and 2013. One patient had a myocardial infarction and one had a cardiac arrest, but there were no deaths. Aside from this, the data from these patients is so sparse and poorly presented that it is difficult to glean much useful information from the paper.
The authors conclude that:
Conservative treatment is safe and effective for body packers.
This is most likely true, given the caveat that it applies to asymptomatic body packers only, and that “conservative treatment” specifically means not performing surgery routinely but only as indicated by clinical signs and symptoms. Unfortunately, as with much of the literature on this topic, it is far from proven by the evidence.
Periodically, Hillingdon Hospital publishes a review of its experience with body packers. For example, this paper reviewed patients seen between 2000 and 2005. Thus it seems that there are a number of patients being reported multiple times in the literature by this group. I have not previously found these reports coherent or convincing, and this paper is no exception.