Cocaine packet ingestion. Surgical or medical management?

Current controversy focuses on whether patients having ingested packets of cocaine should be treated medically or surgically. We surgically treated two such patients in whom conditions did not allow for conservative medical management, ie, the packets caused small-bowel obstruction in one patient while toxic manifestations of cocaine occurred in the other patient. Initial emergent surgical treatment vs success with conservative medical management appears to be directly related to whether a patient voluntarily receives treatment or is involuntarily brought to the hospital on suspicion of smuggling cocaine packet ingestion. Early surgical intervention is warranted unless the method of packet construction is known to be of high quality and if the patient is totally asymptomatic. If these criteria are present, intensive care monitoring, with surgical intervention on any change in status, is preferred.