A 28-year-old man brought to the hospital from police custody complained of rectal pain but at first denied that anything was inside his body. He later admitted he had inserted six ampoules of tramadol, an opioid pain medicine, into his rectum. Surgical removal was planned, but before it could happen, the ampoules came out on their own.
The case was published on June 10, 2026, in the journal Case Reports in Surgery by doctors in the Department of General Practice and Emergency Medicine at BP Koirala Institute of Health Sciences in Dharan, Nepal. The authors called the concealment of drug ampoules “an unusual clinical scenario” and used the case to alert colleagues to a problem that rarely announces itself: patients who hide drugs inside their bodies and are reluctant to say so.
A Denial That Delayed the Diagnosis
According to the report, the man had a history of intravenous drug use. When he arrived, his main complaint was pain in the rectal area. Only after first denying any concealment did he tell clinicians what he had done. Clinical examination and imaging then confirmed foreign bodies in his rectum.
The authors built the report around what they called delayed disclosure. In their abstract, they wrote that hidden drug ampoules pose diagnostic and management challenges because of the late admission, the risk of drug leakage, and the difficulty of retrieving the objects. Their main lesson for clinicians was direct: the case underscores “the importance of early suspicion, detailed history-taking, and prompt imaging in suspected rectal foreign bodies.”
Reluctance to speak up is a familiar pattern even outside drug cases. A StatPearls review on rectal foreign body removal, published by the National Library of Medicine, notes that “due to associated stigma, patients often delay seeking care, increasing the risk of complications.” For a person in police custody, fear of legal consequences may add another reason to stay quiet.
Fragile Glass, Not Sealed Packets
The authors tagged their report with the term body stuffers, placing the case alongside a well-known toxicology problem. According to the MSD Manual Professional Edition, body packing usually means deliberately swallowing well-sealed packets of drugs to smuggle them past checkpoints such as international borders. Body stuffing, by contrast, refers to quickly swallowing or placing poorly packaged or unpackaged drugs into body cavities, including the mouth, rectum, or vagina, when arrest is imminent.
In both situations, the main danger is that the container fails. The MSD Manual treats packet rupture as the leading concern and notes that symptoms depend on which drug was hidden. In this case, the containers were not wrapped packets but medical ampoules, which the authors described as “fragile drug-containing ampoules.” A broken ampoule could release its contents inside the body.
Tramadol is not a harmless drug in overdose. A StatPearls overview of tramadol notes that the U.S. Food and Drug Administration approved it for moderate-to-severe pain. In the United States, it has been a Schedule IV controlled substance since 2014, when the Drug Enforcement Administration placed tramadol into Schedule IV because of its potential for misuse. The StatPearls review explains that overdose can cause dangerously slowed breathing and seizures, a combination that sets tramadol apart from many traditional opioids. Treatment is also tricky: naloxone, the opioid reversal drug, may ease breathing and central nervous system depression but can raise the risk of seizures.
A Lucky Outcome the Authors Say Not to Copy
Before the planned surgery could take place, all six ampoules were expelled spontaneously. The report states that this happened without complications and that follow-up imaging verified the objects were gone.
The authors acknowledged that in stable patients, conservative care with laxatives may allow an object to pass naturally and spare the patient an invasive procedure, as it did here. But they added a firm caveat. The result, they wrote, “should be seen as a positive outcome rather than a recommended management approach, especially in cases involving fragile drug-containing ampoules.”
That caution fits standard guidance on rectal foreign bodies. The StatPearls review says plain X-rays of the abdomen and pelvis are usually the first imaging test, with a CT scan preferred when an object does not show up on X-ray or when complications such as perforation are suspected. Many objects can be removed at the bedside with sedation, but the review says manual removal should be deferred when an object is sharp or fragile, or when signs of abdominal lining inflammation are present, because those cases need an operation.
The review lists perforation with peritonitis, a serious infection of the abdominal lining, as the most serious complication. It warns that delayed or incomplete removal can lead to tissue damage from pressure, abnormal tunnels between organs called fistulas, or sepsis. For patients identified as body packers, the review advises going directly to the operating room under general anesthesia with minimal handling, because a ruptured drug packet can cause rapid poisoning.
The outcome in Nepal was fortunate, not proof that waiting is safe. A single case report cannot show how often such objects pass without harm, and it does not change how clinicians are advised to manage suspected drug concealment.
Lessons for Emergency Rooms and Custody Settings
The report’s broader value lies in its warning about trust and timing. A patient who denies hiding anything may still be carrying something dangerous, and the longer the truth stays hidden, the less time clinicians have to act before a container breaks or tissue is damaged.
Patients brought from police custody can present an especially tricky picture. They may fear legal consequences, and clinicians may have only vague symptoms, such as rectal pain, to go on. The authors’ advice is to keep concealment in mind and to order imaging early rather than wait for a full confession.
For the public, the takeaway is not that this is a common risk. The authors themselves described the scenario as unusual. But anyone with an object lodged in the rectum, or who has hidden drugs inside the body, faces real medical danger and should get emergency care right away. Severe abdominal pain, fever, rectal bleeding, drowsiness, slowed breathing, or seizures all call for immediate medical attention.
Key Questions Answered
What happened in this case?
A 28-year-old man with a history of intravenous drug use was brought from police custody with rectal pain. He first denied hiding anything, then admitted inserting six tramadol ampoules into his rectum. Examination and imaging confirmed the objects, and they came out on their own without complications before planned surgery.
Where was the case reported?
Doctors in the Department of General Practice and Emergency Medicine at BP Koirala Institute of Health Sciences in Dharan, Nepal, described it in Case Reports in Surgery on June 10, 2026.
What is body stuffing?
Body stuffing means hastily swallowing or placing poorly packaged or unpackaged drugs into body cavities, such as the rectum, when arrest is imminent. It differs from body packing, which typically involves swallowing well-sealed packets to smuggle drugs.
Why were the ampoules dangerous?
The authors described them as fragile. A broken ampoule could release tramadol, which in overdose can cause dangerously slowed breathing and seizures.
Should doctors wait for objects like these to pass naturally?
No. The authors said the spontaneous expulsion should be seen as a positive outcome, not a recommended approach, especially with fragile drug-containing ampoules. Standard guidance calls for prompt imaging and removal, with surgery for fragile objects or signs of complications.
Published by Medicaldaily.com
