Police Suspected Swallowed Drug Packets, but the Round Shapes on His CT Scan Were Fufu

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They were balls of fufu, a starchy staple eaten across West and Central Africa that is traditionally rolled into small portions and swallowed without chewing. Doctors from University Hospitals of Geneva described the mix-up in a case report titled “Don’t chew the fufu,” first published in the open research platform F1000Research in 2019 and revised after peer review in 2021.

The encounter took place in November 2018. Police suspected body stuffing, which means hurriedly swallowing drug packets to avoid arrest. A low-dose abdominal CT showed “multiple foreign bodies of similar appearance in the stomach,” with some reaching the first part of the small intestine, called the duodenum.

The man, described in the report as young, healthy and from western Africa, denied swallowing any packets. He told doctors he had only eaten fufu the previous evening and repeated that account after he was admitted to a secured hospital ward. According to the report, fufu is compacted by hand into small balls that are usually swallowed without chewing to keep a feeling of fullness throughout the day. It was his usual single daily meal.

That detail changed the medical picture. Dense balls of food eaten the night before and swallowed whole could plausibly still be sitting in the stomach and upper intestine the next day. In the emergency department, his vital signs were normal and his abdominal exam was unremarkable.

With that history in hand, the radiologist reviewed the images again with a supervisor. The objects had irregular borders and came in different sizes, consistent with food being digested.

Real drug pellets usually look different. The authors note that manufactured pellets have “clearly defined and regular edges” and, if machine-made, would be the same size and shape. The team informed the criminal justice authorities, and the man was quickly discharged from the secured ward.

The authors drew a direct lesson for radiology. They stressed “the importance of a history of food intake that could bias the interpretation of CT scan images.” A few questions about his last meal, asked before or alongside the scan, might have spared him a longer stay under suspicion. A version of the report is also available on PubMed Central, the National Institutes of Health’s free archive.

The report separates two practices that are often confused. Body packers deliberately swallow well-sealed pellets to smuggle drugs, often 50 to 100 of them, according to the case report. Body stuffers swallow smaller, more fragile, often loosely wrapped packets at the last moment, usually to hide evidence from police.

Emergency teams take both seriously because a leaking packet can release a large dose of a drug at once. The MSD Manual, a professional medical reference, warns that “Rupture of a single cocaine packet can be fatal.”

Imaging research shows why CT is often the tool of choice. A 2008 study in the journal Abdominal Imaging examined 12 people who had swallowed opium packets and found that all packets were visible on CT done without contrast dye. Their average density ranged from roughly 164 to 205 Hounsfield units, the scale radiologists use to compare how dense tissues and objects appear. The patients averaged 28 years old, and 11 of the 12 were men. One patient, an 18-year-old woman, died of opium toxicity. The authors concluded that CT “could be a suitable imaging modality in identifying opium packets, similar to that reported for cocaine and heroin.”

That high-stakes context helps explain why a doctor looking at a stomach full of round shapes might jump to the dangerous answer first. It also shows how a false positive can carry consequences beyond medicine, including extended custody and suspicion of a crime.

The Geneva team’s broader point is that culture and diet belong in the medical history. Fufu is a popular dish in western and central African countries and, through migration, in the Caribbean as well, according to Britannica. Many clinicians outside those communities may never have seen it on a scan.

The mistake came from interpretation rather than from the scanner. The first reading was made with an expectation already in place, since police had brought the man in on suspicion of swallowing drugs. In their revised report, the authors add that the images actually looked more like body packing than the body stuffing police had suspected. Once doctors had a competing explanation, the same images supported it.

The case is a single report, and it does not measure how often food is mistaken for drug packets on CT. It does show a specific blind spot: dense, rounded portions of food swallowed whole can look alarmingly like contraband. For hospitals that routinely scan people brought in by police, the authors’ advice is simple. Ask what the patient ate, and let the answer shape how the images are read.

Multiple similar-looking round objects in the man’s stomach and duodenum, first reported as compatible with drug pellets.

Balls of fufu, a starchy West and Central African staple traditionally swallowed without chewing.

On review, the objects had irregular edges and different sizes, consistent with digestion. Manufactured drug pellets usually have regular edges and a uniform size.

Hastily swallowing small, fragile drug packets to avoid arrest. The packets can leak and cause a dangerous overdose.

Asking what a patient recently ate can change how CT images are interpreted and help prevent a false accusation.