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Previous Volume 339:1333-1334 October 29, 1998 Number 18 Next

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To the Editor: With respect to the "Medical Mystery" Image in Clinical Medicine (Sept. 10 issue),¹ a review of the student's financial-aid package will probably not reveal a full scholarship. "Body packing" is a method of importing drugs through U.S. customs. The student most likely swallowed the 70 or so sealed balloons or condoms filled with heroin or cocaine. The contents are usually passed through and recovered, but in the Image (Figure 1) they appear to have become impacted. Rupture of one of the balloons can lead to an overdose and death for the smuggler, or "mule."

View larger version (134K): [in this window] [in a new window]   Figure 1. A Medical Mystery.

 

R. Hal Baker, M.D.
York Hospital
York, PA 17405

References

1. Mahoney MS, Kahn M. A medical mystery. N Engl J Med 1998;339:745-745. [Free Full Text]

James L. Mills, M.D.
National Institutes of Health
Bethesda, MD 20892

Witness the perils of ill-gotten gain,

Imagine the colic, the cramps, and the pain

Bestowed on the fool

Who agrees to be "mule,"

Ingesting small packets filled with cocaine.

Theodore N. Keltz, M.D.
Bernard Gitler, M.D.
Sound Shore Medical Center
New Rochelle, NY 10802

The pain's grown too great for this drug-bearing "mule,"

For he's impacted with packets, not with bezoars or stool;

With his plight and his pain at our heartstrings he tugs,

But this colic's self-caused from ingesting these drugs;

For the future I'd advise him to avoid further pain:

Eat fresh fruit and veggies, not bags of cocaine;

His schooling by all means should be brought to fruition,

But better ways must be sought to fund his tuition!

Timothy S. Naimi, M.D., M.P.H.
534 Pelham Blvd.
St. Paul, MN 55104

To the Editor: The abdominal plain film was taken immediately after this 20-year-old student was admitted to the hospital. After arriving at an airport from Colombia, the man experienced abdominal pain, became frightened, and confessed to authorities that he had ingested 100 packets each containing approximately 5 g of cocaine. He was arrested and taken to the hospital immediately. His vital signs were normal. The man refused surgery and was treated initially with osmotic cathartics. It took two days for all the packets to pass.

The packets were made of the fingertips of latex gloves that had been folded back and tied off at both ends with dental floss, a method consistent with the type 1 package described by McCarron and Wood.¹ This method is associated with high rates of leaching and rupture and with a higher rate of morbidity and mortality than other kinds of packaging. Fortunately, this patient, unlike many others, survived.

The student had promised to be a "mule" for $1,000. The street value of the cocaine at that time was approximately $20,000. He indicated that he was part of a large drug-smuggling operation in South America. The student is now serving a five-year term at a minimum-security prison. He will be deported on his release.

Michael S. Mahoney, M.D.
Marc Kahn, M.D.
Tulane University School of Medicine
New Orleans, LA 70112-2699

References

1. McCarron MM, Wood JD. The cocaine "body packer" syndrome: diagnosis and treatment. JAMA 1983;250:1417-1420. [Abstract]

Jerome P. Kassirer, M.D.

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