Pidoto Rocco Roberto, Agliata Anna Maria, Bertolini Roberto, Mainini Alberto, Rossi Gianfranco, Giani Giuseppe
Emergency Department, S. Antonio Abate Hospital, Gallarate, Italy.
J Emerg Med. 2002 Aug;23(2):149-53. doi: 10.1016/s0736-4679(02)00505-x.
Clinical outcome of cocaine body packers is considered to be unpredictable and there are no clear guidelines for the management of these patients. Their surveillance in casualty wards, where they are usually admitted during evacuation of the packets, can be very difficult. The authors refer to a new type of cocaine packet, allowing these patients to be managed with a more conservative approach than in the past, and report their experience with 161 body packers, observed from January 1999 to December 2000. They adopted a surveillance protocol providing only minimal medical intervention. Among 161 body packers, 142 (88.2%) evacuated the ingested packets without significant symptomatology. Warning symptoms were present in 19 (11.8%) patients. Three patients (1.9%) presented with marked anxiety but none had cocaine in the urine sample. Fifteen (9.3%) body packers complained of colicky pain, and all underwent plain X-ray studies of the abdomen. Ten (6.2%) of them without radiologic signs of intestinal occlusion recovered with food deprivation and medical treatment, while five (3.1%) underwent laparotomy, three patients (1.9%) for gastric occlusion and two (1.2%) for ileal occlusion. Only one patient (0.6%) had warning symptoms and a urine screen positive for cocaine metabolites. In three cases of gastric occlusion, a gastrotomy was accomplished. In two cases of ileal occlusion, and in the patient with cocaine intoxication, packets were milked into the cecum, and some into the descending colon and rectum, until anal expulsion, by gentle pulling. Type 4 packets represent a new method of cocaine packaging, carrying the possibility of treating these body packers more conservatively than those transporting previous type of packets. Surgical approach to intestinal occlusion also may be conservative, because distal propulsion of the packets can be accomplished without entering the intestine.
可卡因体内藏毒者的临床结局被认为不可预测，且对于这些患者的管理尚无明确指南。在急诊病房对他们进行监测非常困难，因为他们通常是在包裹排出过程中被收治的。作者提到了一种新型可卡因包裹，这使得这些患者能够采用比过去更保守的方法进行管理，并报告了他们在1999年1月至2000年12月期间观察到的161例体内藏毒者的经验。他们采用了一种仅提供极少医疗干预的监测方案。在161例体内藏毒者中，142例（88.2%）排出了摄入的包裹，且无明显症状。19例（11.8%）患者出现了警示症状。3例患者（1.9%）表现出明显焦虑，但尿样中均未检出可卡因。15例（9.3%）体内藏毒者主诉绞痛，均接受了腹部X线平片检查。其中10例（6.2%）无肠道梗阻的放射学征象，通过禁食和药物治疗后康复，而5例（3.1%）接受了剖腹手术，3例患者（1.9%）因胃梗阻接受手术，2例（1.2%）因回肠梗阻接受手术。只有1例患者（0.6%）出现警示症状且尿筛查可卡因代谢物呈阳性。在3例胃梗阻病例中，实施了胃切开术。在2例回肠梗阻病例以及可卡因中毒患者中，通过轻柔牵拉将包裹挤入盲肠，部分挤入降结肠和直肠，直至从肛门排出。4型包裹代表了一种新的可卡因包装方式，与运输以前类型包裹的体内藏毒者相比，有可能对这些体内藏毒者进行更保守的治疗。对于肠道梗阻的手术方法也可能较为保守,因为可以在不进入肠道的情况下实现包裹的向远侧推进。
