CONSERVATIVE MANAGEMENT OF COCAINE-PACKET INGESTION - EXPERIENCE IN MILAN, THE MAIN ITALIAN SMUGGLING CENTER OF SOUTH-AMERICAN COCAINE

Objective. To assess retrospectively the effectiveness and the safety of the conservative medical management of asymptomatic cocaine body-pa ckers. Design. Case series collected during twelve years (1980-1992). Setting. Milan Airports Health Center. Department of Surgery and Inten sive Care Unit of San Raffaele Hospital University of Milan. Participa nts. 189 suspected cocaine body packers (143 male, 53 female), aged be tween 18-53 years, were brought to our observation by customs after di sembarking at the Milan International Airports of Malpensa and Linate, 61 subjects (32%) turned to be carriers of packets containing cocaine (ovules). Interventions. Medical conservative treatment, based on clo se clinical observation and light solid diet, free assumption of liqui ds and oily laxatives, Plain abdominal X-ray and ultrasound were perfo rmed for the diagnosis of cocaine packet ingestion and then repeated u p to the complete evacuation of all ovules, Two laparotomies with surg ical removal of ovules in symptomatic patients (bowel obstruction and acute cocaine intoxication due to the intraluminal rupture). Measures. Physical examination with neurological assessment every 8 hours and v ital signs (including blood pressure, heart frequency and temperature) every 4 hours to detect complications (acute cocaine intoxication, bo wel obstruction or perforation) secondary to cocaine packet ingestion. Structural features of the containers, cocaine amount per ovule, and rate and indications for surgical treatment have been reviewed. Result s. Evacuation period lasted from 3 to 6 days, Ingested containers vari ed from 52 to 117 with a mean of 88+/-13 ovules for each body packer, Total amount of recovered 95% pure cocaine hydrochloride was 41 kilogr ams, Signs of cocaine toxicity and bowel obstruction requiring emergen cy laparotomy occurred in two cases (3.3%), Both patients recovered un eventfully. Conclusions. Conservative management during spontaneous ev acuation of the containers is the first choice approach to the body-pa cket ingestion, Close clinical observation allows an early detection o f the patients with complications requiring emergency surgical treatme nt.