Body-packing is a common method of smuggling cocaine. Complications requiring surgery do not occur with sufficient frequency to allow any individual surgeon to determine patterns of presentation and the best approach to the conduct of surgery. A survey of all surgical units in Jamaica was conducted. A case was any patient requiring surgery for cocaine body-packing since and including the first reported case in 1987. Seventeen cases were identified. There were 11 cases of bowel obstruction, two of delayed passage of pellets, three of ruptured pellets with cocaine toxicity and one patient panicked and requested surgery. The distal ileum was the commonest site of obstruction in the normal gastrointestinal tract. In all three cases with cocaine poisoning, the ruptured packets were encountered in the upper gastrointestinal tract and several other partially ruptured packets were also found, implying that poor packaging was the cause of rupture. Obstructing packets should be removed but non-obstructing, unruptured packets encountered in the colon may safely be allowed to pass spontaneously. All cases of packet rupture with cocaine toxicity should have immediate surgery.