'Surgical mules': the smuggling of drugs in the gastrointestinal tract

Patients are frequently found carrying illicit drugs in the gastrointestinal tract in hospitals sited close to international airports. Drugs, usually heroin or cocaine, are wrapped in cellophane packets or condoms. Packages are concealed by being swallowed or passed into the rectum. The majority of drug traffickers do not require any medical intervention. Recent reports have suggested that these patients are best treated expectantly avoiding any operative procedures.

However, the quantity of drug in any one of the ingested packets is usually above the toxic dose and acute drug toxicity, as well as bowel obstruction, can result in fatalities. The presentation and treatment of five patients, who presented over a period of 2 years close to Heathrow Airport, London are reviewed and the management of 'surgical mules' discussed. It shows that conservative treatment is appropriate providing bowel obstruction or package perforation has not occurred.