Fulminant Postoperative Peritonitis Following Cocaine Packet Rupture in a Body Packer

Body packing carries a well-documented risk of life-threatening complications, particularly in packet rupture. Postoperative peritonitis following intraperitoneal contamination in the absence of bowel perforation remains an unusual complication. A 32-year-old man was brought to the emergency department by law enforcement following arrest at an international airport on suspicion of drug trafficking. He presented with diffuse abdominal pain and haemodynamic instability consistent with sympathomimetic toxicity. Abdominal computed tomography (CT) confirmed at least 85 cocaine packets throughout the gastrointestinal tract. Rapid clinical deterioration prompted emergency laparotomy, all packets were retrieved, and one was found ruptured, with no bowel perforation or ischaemia. Despite complete surgical decontamination, the patient developed fulminant postoperative peritonitis with disseminated intravascular coagulation and multiorgan failure. He died on postoperative day 2. Intraperitoneal cocaine contamination may lead to a rapidly progressive and potentially fatal course, even after apparently adequate surgical decontamination. Early multidisciplinary management and close postoperative monitoring are essential.