Contrast CT scan fails to detect the last heroin packet

The Journal of Emergency Medicine
In-Hei HahnLewis S Nelson

Abstract

We report on the comparative utility of the abdominal computed tomography (CT) scan and contrast-enhanced plain radiography in one case of a "body packer" who claimed to have passed 50 out of 55 packets before being brought to the Emergency Department by the police for further gastrointestinal decontamination. The presence of retained packets was confirmed by plain radiography. The patient received whole bowel irrigation (WBI) with polyethylene glycol electrolyte solution (PEG-ELS) and passed four more packets. A helical abdominal CT scan with oral contrast was performed to identify any residual packets. A negative CT scan and a reliable patient prompted a subsequent upright abdominal radiograph that showed the last packet in the right lower quadrant. This packet ultimately passed with continued WBI. This case illustrates the failure of CT scan to identify the last packet and suggests that multiple modalities may be necessary to fully confirm a therapeutic endpoint.

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Citations

Jul 5, 2007·Abdominal Imaging·Morteza Sanei TaheriVahideh Nahvi
Mar 16, 2013·Abdominal Imaging·Nicholas J ConnorsLewis S Nelson
Aug 24, 2007·Emergency Radiology·Anshuman Sengupta, Patrick Page
Feb 14, 2013·Forensic Science, Medicine, and Pathology·Saiful Nizam Bin Abdul RashidPatricia M Flach
Apr 18, 2009·Southern Medical Journal·S A de Beer, P R Fa-Si-Oen
Oct 14, 2011·International Journal of Emergency Medicine·Timothy E AlbertsonAndrew L Chan
Jan 19, 2013·Iranian Journal of Radiology : a Quarterly Journal Published by the Iranian Radiological Society·Makhtoom ShahnaziRamin Pourghorban
Dec 3, 2014·Disease-a-month : DM·Trevonne M ThompsonTimothy B Erickson
Jan 30, 2014·The British Journal of Radiology·A PintoL Brunese
Sep 3, 2009·Case Reports in Medicine·Manuel Jesus Soriano-PerezAlfonso Cruz-Caballero
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