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When Congo national Alpha Mwamba Tshouke, 51, was planning to smuggle cocaine into the country, he did not realise that he would make it to a medical journal, thanks to the way he transported the stash, which called for an intervention by medical professionals.
He had swallowed 116 pellets stuffed with cocaine weighing 1.5 kg, worth approximately ₹ 15 crore.
While it isn’t uncommon for the hospital to come across such a case, Tshouke’s situation was challenging as laxatives could expel only 115 pellets. Doctors had to perform an endoscopy-guided laparoscopy surgery to pull out the lone pellet that remained dangerously stuck at the far end of his stomach for 10 days since his arrest, making it an interesting case for submission to a medical journal.
The state-run hospital has seen close to 35 similar cases over the last five to six years. The highest number of drug-filled pellets removed from a body stands at 126.
The 6ft 3-inch man was arrested by the Directorate of Revenue Intelligence (DRI) and brought to the Sir JJ Hospital on September 2, around 10.15 pm.
“As a routine procedure, we did his X-Ray and CT-Scan, counting the exact number of pellets inside his body. We then gave him laxatives and normal food and waited for him to pass stool,” said Dr Amol Wagh, associate professor, surgery department, who operated on Tshouke.
On day one, he managed to purge 87 pellets, followed by 19 the second day and nine the third. “We then had to wait for the last pellet to leave the body naturally,” said Dr Akshay Kadam, the third-year resident doctor, who first took care of Tshouke.
The Congo national was supervised by a team of five members, which included a DRI official, resident doctor, staff nurse and administrative officer to document the purged pellets.
The wait for the last pellet was protracted. “When he didn’t pass it through the stool on the sixth day, a CT scan was done which showed it stuck in the end of his stomach. Gastroenterologists diagnosed it could be life-threatening if extracted endoscopically from the mouth,” said Dr Shirish Bhagvat, unit in-charge who handled the gastroscope during the surgery.
The team of doctors first considered an open surgery, but finally conducted laparoscopy so that he could get away with minimal cuts and recover early. Language was another challenge to communicate with Tshouke. “Since he spoke French, we used sign language and Google translator to communicate. To get the consent for surgery, we got help from DRI’s translator,” said Dr Kadam.
Tshouke, who weighs 100 kg, was taken for surgery in the afternoon of September 14. It took the doctors an hour to remove the last pellet.
“Three holes of 5 to 12 mm were made. A camera was inserted endoscopically, through the mouth to guide the laparoscopic procedure. A special basket and forceps were pushed in from the other holes in the stomach and the pellet – measuring close to 6X2 cms and weighing 40 gm -- was scooped out,” said Dr Bhagvat.
“If it had burst inside the stomach, it would have led to an instant death, as we do not have an antidote to it. His first words after gaining consciousness post-surgery were ‘thank you’ to us,” said Dr Wagh.
Tshouke, who prefers to sleep most of the time, will be discharged and handed over to DRI custody in the next two-three days.
JJ Hospital’s surgery team has won international awards for its innovations in laproscopic surgeries, including the prestigious Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). “This was a unique case as was our approach. We are going to present this case in international medical forums and journals,” said Dr Ajay Bhandarwar, head of the surgery department.
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