A 37-year-old male with no relevant medical history came to the emergency department guarded by police officers from the airport due to suspected ingestion and intra-abdominal transport of drug wraps (BP).
During the course of a regular flight, the patient presented a convulsive episode followed by three foreign bodies orally.
On arrival, the patient had: blood pressure 157/88 mmHg, heart rate 108 beats/min, temperature 37oC and O2 saturation 94%.
On examination, the abdomen was distended and killed to percussion, non-painful, with multiple foreign bodies in mesogastrium and without peritonitis.
Neurologically, he showed mild mydriatic pupils, Glasgow 15 and absence of neurological focality.
Abdominal radiography confirmed the presence of multiple radio-opaque intra-abdominal foreign bodies.
The most relevant laboratory findings were: leukocytes 14.1 x 109/l (neutrophils: 86%), creatinine 1.7 mg/dl and glucose 131 mg/dl. The electrocardiogram showed sinus tachycardia.
Urine analysis was positive for cocaine, its metabolites and benzodiazepines.
Defecation treatment was initiated with polilenglicol solution (Casenglicol®) and clinical observation.
Two hours after admission the patient suffered an episode of psychomotor agitation and tachycardia (120 beats/min), followed by decreased level of consciousness, incoordination motor tonic unit, mydriasis intensive care and seizures.
Clonazepam (1 mg) and diazepam (10 mg) e.v. were administered and an urgent laparotomy was performed.
After accessing the abdominal cavity, multiple foreign bodies of hard consistency were identified throughout the digestive tract.
A transverse gastrotomy was performed at antral level, a longitudinal ileotomy at 15 cm from the ileocecal valve and two longitudinal colotomy (at transverse colon and sigmoid level), with multiple extractions.
An antegrade rectal-sigma washed with saline solution through a colotomy, evacuating four other packages distal to the pronation.
A total of 96 cylinical foreign bodies measuring 5 cm in length with multilayer latex, smooth, compact and apparently resistant manufacturing were extracted.
The packages showed visible signs of rupture.
The patient remained under observation for 24 hours in an intensive care unit.
Peristalsis and oral diet began on the second postoperative day.
The patient had a correct subsequent evolution and was discharged on the fourth postoperative day.
