Body Packers in Costa Rica: Clinical Management and Medico-Legal Framework

Abstract

Intracorporeal drug transport (“body packing”) poses dual clinical and medico-legal challenges: safeguarding patient health while preserving forensic evidence.
Objective: To describe clinical management and specify medico-legal procedures for individuals who carry drugs intracorporeally, with operational considerations for Costa Rica. Methods: Narrative review of literature (2016–2024) in Spanish and English using DeCS/MeSH-aligned terms related to body packing, forensic medicine, surgery, and radiology; selection of relevant articles and guidance documents. Findings: Diagnosis relies on targeted history and non-contrast abdominopelvic computed tomography as the test of choice; plain radiography may assist. Asymptomatic patients require in-hospital observation, vital-sign monitoring, stool monitoring/counting of expelled packets, and protocolized whole-bowel irrigation (polyethylene glycol). Oil-based laxatives and endoscopy are discouraged. Surgery is indicated for obstruction, perforation, or packet rupture with toxicity; laparotomy remains most used. In Costa Rica, medico-legal assessment requires a judicial order; chain of custody is ensured, and the forensic physician does not extract the material—clinical teams prioritize patient safety.
Conclusions: Protocolized pathways integrating clinical criteria and medico-legal directives improve patient safety and evidence preservation in body-packing cases.