{"id":2467,"date":"2023-07-10T16:01:31","date_gmt":"2023-07-10T14:01:31","guid":{"rendered":"https:\/\/angh.net\/abstracts\/?p=2467"},"modified":"2023-09-11T16:06:03","modified_gmt":"2023-09-11T14:06:03","slug":"un-bezoard-cocaine","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/un-bezoard-cocaine\/","title":{"rendered":"Un bezoard cocain\u00e9."},"content":{"rendered":"

2023<\/b><\/p>\n

Aymerik Mage, Florence Skinazi, Caroline de Kerguenec, Zakarya Kebir.
Service d\u2019H\u00e9patogastroent\u00e9rologie H\u00f4pital Delafontaine 93200 Saint Denis
<\/em>
Gastroent\u00e9rologie <\/b> – 29\/04\/2023 – Cas clinique web<\/p>\n

Un patient de 27 ans est amen\u00e9 par la police aux urgences de Saint Denis (93200) le 23 d\u00e9cembre 2022 car il n\u2019arrive plus \u00e0 manger. <\/span><\/p>\n

En effet, il a aval\u00e9 dix jours auparavant au Surinam 106 capsules de coca\u00efne bien emball\u00e9es dans du plastique . Il a ensuite quitt\u00e9 rapidement le Surinam  <\/span>en avion pour se rendre \u00e0 Rotterdam. De l\u00e0, il a \u00e9t\u00e9 conduit par des amis dans un h\u00f4tel \u00e0 Lille o\u00f9 lui a \u00e9t\u00e9 donn\u00e9 un traitement laxatif dans l\u2019espoir de r\u00e9cup\u00e9rer le butin.<\/p>\n

Les laxatifs sont rest\u00e9s sans effet. Le patient a vomi environ une dizaine de capsules  <\/span>mais impossible d\u2019\u00e9vacuer le reste. <\/span><\/p>\n

Se sentant ballonn\u00e9, anxieux, n\u2019arrivant plus \u00e0 s\u2019alimenter ni \u00e0 aller \u00e0 la selle, le patient a pr\u00e9f\u00e9r\u00e9 se rendre  <\/span>au commissariat de son domicile. <\/span><\/p>\n

Il a ensuite \u00e9t\u00e9 rapidement conduit aux urgences de l\u2019h\u00f4pital o\u00f9 le gastroent\u00e9rologue a \u00e9t\u00e9 appel\u00e9.<\/p>\n\n\n

La solution !<\/strong><\/p>\n\n\n\n


Le patient est anxieux mais calme, il n\u2019a pas mang\u00e9 depuis 24 heures car il vomit tout ce qu\u2019il mange. Il ne pr\u00e9sente pas de signe de choc.
Cliniquement, on note un emp\u00e2tement \u00e9pigastrique, l\u2019abdomen est souple. Le toucher rectal est normal
On l\u2019aura compris ce bizarre bezoard s\u2019apparente, \u00e0 y regarder de plus pr\u00e8s, \u00e0 une tr\u00e8s \u00ab classique \u00bb occlusion haute.
Un scanner abdomino pelvien est r\u00e9alis\u00e9 et retrouve d\u2019innombrables capsules dans l\u2019estomac qui est distendu. Il n\u2019y a pas de capsule dans le gr\u00eale ou le colon
<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

En raison du nombre de capsules ing\u00e9r\u00e9es, il ne semble pas r\u00e9alisable de les retirer par voie endoscopique et une extraction chirurgicale est d\u00e9cid\u00e9e
Une gastrotomie par une courte laparotomie permet d\u2019extraire les capsules de coca\u00efne qui sont soigneusement compt\u00e9es
Les suites sont simples et le patient sort rapidement sous surveillance polici\u00e8re puis est pris en charge par la justice.<\/p>\n\n\n\n

Les personnes transporteurs de drogues dites \u00ab mules \u00bb ou body packers sont maintenant bien connues. Les principaux produits concern\u00e9s par l\u2019emballage corporel sont l\u2019h\u00e9ro\u00efne, la coca\u00efne et le haschich. Il y a les bodypackers qui introduisent les produits dans un orifice : oreille, rectum, vagin avec des objets ovales mesurant 4 \u00e0 6 cm de longueur et ceux qui les avalent , capsules plus rondes, ce qui n\u00e9cessite d\u2019utiliser des laxatifs, des antispasmodiques pour les \u00e9vacuer.
Les gastroent\u00e9rologues sont concern\u00e9s car souvent appel\u00e9s pour r\u00e9aliser des extractions endoscopiques qui sont d\u00e9licates car menac\u00e9es par l\u2019ouverture d\u2019un des sachets, d\u2019autant plus s\u2019il n\u2019y a pas d\u2019antidote connu comme pour la coca\u00efne. Ces corps \u00e9trangers contenant la drogue sont de mieux en mieux emball\u00e9s par les trafiquants (gants en latex, pr\u00e9servatifs et ballons jouets, papier alu) pour \u00e9viter les risques de rupture, de surdosage mortel et auss de d\u00e9tection aux fronti\u00e8res. Mais aussi, cela entraine une inertie de leur \u00e9vacuation surtout si la quantit\u00e9 introduite est importante.
Dans des conditions normales, le passage spontan\u00e9 d’un sachet rempli de drogue \u00e0 travers le syst\u00e8me digestif se produit dans les 30 h (1). Chaque paquet aval\u00e9 contient en moyenne 3 \u00e0 6 g de coca\u00efne [ 2].  Afin de retarder le temps de transit intestinal, les body packers peuvent d\u00e9lib\u00e9r\u00e9ment prendre des agents anticholinergiques pour r\u00e9duire la motilit\u00e9 intestinale. Ils restent \u00e0 jeun dans l\u2019avion, puis, une fois arriv\u00e9s \u00e0 destination, des laxatifs type PEG ou des lavements intrarectaux sont utilis\u00e9s pour faciliter leur \u00e9vacuation.
Parfois, comme dans notre cas clinique, les paquets ne sortent pas, c\u2019est alors un tableau d\u2019occlusion haute sur \u00ab pseudo bezoard \u00bb. L\u2019extraction chirurgicale est alors indiqu\u00e9e (3).
<\/p>\n\n\n\n

Bibliographie<\/strong>
1 Schaper A, Hofmann R, Bargain P, Desel H, Ebbecke M, Langer C. Traitement chirurgical chez les emballeurs de coca\u00efne et les pousseurs de corps. Int J Colorectal Dis. 2007 ; 22 :1531\u20131535. <\/p>\n\n\n

2.\u00a0de Beer SA, Spiessens G, Mol W, Fa-Si-Oen PR.\u00a0Chirurgie de l’emballage corporel dans la Cara\u00efbe : une \u00e9tude r\u00e9trospective de 70 patients.\u00a0Monde J Surg.\u00a02008\u00a0;\u00a032\u00a0:\u00a0281\u2013285.\u00a0discussion 286\u2013287<\/p>\n

3.Pinto\u00a0A,\u00a0Reginelli\u00a0A,\u00a0Pinto\u00a0F,\u00a0Sica\u00a0G,\u00a0Scaglione\u00a0M,\u00a0Berger\u00a0FH,\u00a0Romano\u00a0L, and\u00a0Brunese\u00a0L.\u00a0Radiological and practical aspects of body packing.\u00a0 Br JRadiol\u00a02014;\u00a087:\u00a020130500.<\/p>\n

T\u00e9l\u00e9charger MP4<\/a><\/p>\n

(Vid\u00e9o :<\/em> Zakarya Kebir Service d\u2019H\u00e9patogastroent\u00e9rologie H\u00f4pital Delafontaine 93200 Saint Denis <\/em>– Tous droits r\u00e9serv\u00e9s – Copyright 2023 – )
<\/em><\/p>\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

2023 Aymerik Mage, Florence Skinazi, Caroline de Kerguenec, Zakarya Kebir.Service d\u2019H\u00e9patogastroent\u00e9rologie H\u00f4pital Delafontaine 93200 Saint DenisGastroent\u00e9rologie – 29\/04\/2023 – Cas clinique web Un patient de 27 ans est amen\u00e9 par la police aux urgences de Saint Denis (93200) le 23 d\u00e9cembre 2022 car il n\u2019arrive plus \u00e0 manger.  En effet, il a aval\u00e9 dix jours […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[36],"class_list":["post-2467","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-36"],"yoast_head":"\nUn bezoard cocain\u00e9. - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/un-bezoard-cocaine\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Un bezoard cocain\u00e9. - 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