Clinical scenario

A 26 year old man in police custody is brought to the emergency department with abdominal pain. He claims to have ingested a large number of drug filled packages. He is tachycardic. Examination is otherwise normal. You wonder if plain abdominal radiography is indicated.

Three part question

In [patients suspected of internal drug carriage (“Body packers”, “body stuffers”)] is [plain abdominal radiography] of [diagnostic utility]?

Search strategy

Medline 1966-03/04 using the Ovid interface. [(Exp Radiography, Abdominal OR abdominal radiography.mp OR abdominal x-ray.mp OR plain abdominal x-ray.mp OR plain film abdomen.mp) AND (body packers.mp OR body stuffers.mp OR body pack$.mp OR body stuff$.mp)] LIMIT to human AND English language.

Search outcome

Altogether 12 papers were found of which two were relevant to the topic of interest (table 1).

Comment(s)

The possibility of internal carriage of drugs is an increasingly frequent presentation to urban emergency departments. A diagnostic dilemma is usual because of the credibility of the presentation. It is important, therefore, that clinicians understand the utility of any investigations used. In paticular the failure to appreciate the possibility of a false negative result might prove fatal.

CLINICAL BOTTOM LINE

A single abdominal radiograph is insufficiently sensitive to rule out abdominal drug carriage. However, specificivity is high and a positive finding is diagnostic.