A “madd”-ening confounding: fruit seeds mimicking enteral drug concealment by computed tomography

Abstract

Objective

To highlight the similarity between madd fruit seeds and enteral drug concealment (“body packing”) on computed tomography when evaluated by Hounsfield Units.

Case report

A 13-year-old girl from Senegal presented to the Emergency Department with severe abdominal pain. Examination showed right lower quadrant tenderness with rebound. Computed tomography scan of the abdomen and pelvis revealed smooth, well circumscribed, multiple intraluminal foreign bodies measuring up to 2 cm in size with Hounsfield Units measuring up to 200. The emergency department radiologist reported that these were suspicious for “body packer packets” of either opioids or cocaine, based on their appearance and Hounsfield Unit characteristics. Dietary history later revealed consuption of madd fruit (Saba senegalensis) seeds, which can cause bezoar formation and intestinal obstruction.

Conclusion

Madd fruit seeds may appear similar to drug packets on computed tomography with similar Hounsfield Unit characteristics. History and clinical context are paramount to avoid misdiagnosis.

Keywords:

• Madd Fruit
• body packer packet mimics
• Saba Senegalensis
• hounsfield units

Author contributions

Each author has contributed to this publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.