Death of a female ‘drug mule’ from peritonitis: A case report and literature review

Abstract

Concealing drugs inside the body to transport them covertly, known as ‘body packing’, can be fatal. Intestinal occlusion and poisoning are common; fatal gastric perforation is unusual. We present a rare case involving a 54-year-old female ‘drug mule’ (body packer) who died from peritonitis resulting from gastric perforation. The deceased (from Sweden) was discovered dead in her hotel room. A forensic autopsy revealed diffuse peritonitis due to a 2 cm hole in the superior part of the gastric lesser curvature. There were 70 rigid plastic capsules, about 6 cm long and weighing between 3 and 4 g each, inside the stomach, intestines and in the subphrenic space. This case serves as a stark reminder of a rare but serious complication associated with body packing; the volume of the capsules may have exerted enough strain to cause stomach wall ischaemia and rupture. Drug mules are more commonly young men who present with acute signs of poisoning, so the type and site of complication, the victim’s sex and relatively older age make this report stand out as unusual. In conclusion, we need to recognise that gastric perforation poses a serious, life-threatening danger in cases of body packing, particularly if a ‘mule’ swallows large, stiff packets and it is crucial that forensic pathologists and doctors keep this possibility in mind and involve multiple disciplines when dealing with these very high-risk situations. Interdisciplinary policies should be created to manage the care of body packers and to prevent a recurrence.