(via Lancet) Homeland security reaches the anus I wish to bring to your attention difficulties one of my patients recently encountered when entering the USA. He is a 48-year-old man with a fistula- in-ano managed with a long-term seton to control perianal sepsis. A seton consists of a length of suture material knotted to form a loop which lies in the fistula track. It passes through the fistula, out of the external opening beside the anus, into the anus, and re-enters the fistula through the internal opening. Various different materials can be used; in this case the seton was made of a turquoise braided synthetic suture. Many fistulas are treated with setons in the short term, and, in those that are high or associated with Crohnbs disease, this management can be long-term. On arrival in New York in August, 2006, for a holiday, the patient was interrogated by immigration officials, then examined and searched. The presence of the seton gave rise to much concern, I assume because of a suspicion that a drug package or terrorist weapon was in some way attached to it. A rectal examination was done, during which the examining official pulled very hard on the seton, causing severe pain, but fortunately not damaging the anal sphincter muscles encircled by it. The patient was refused entry into the country unless the seton was removed. Given the somewhat stark choice, he chose removal of the seton, which was done by a doctor at the airport who claimed never to have come across one before. The patient now requires an examination under general anaesthetic to insert a replacement. I thought I should highlight this rather bizarre manifestation of b homeland securityb because I suspect that it might become a more frequent problem. I suggest that any patient with a seton who is planning to travel to the USA or any other country where they are likely to be searched in this manner should carry a letter from their specialist explaining the nature of their condition and treatment. I declare that I have no conflict of interest. Sue Clark sue.clark@nwlh.nhs.uk The Polyposis Registry, St Markbs Hospital, Harrow HA1 3UJ, UK -- Eugen* Leitl <a href="http://leitl.org">leitl</a> http://leitl.org ______________________________________________________________ ICBM: 48.07100, 11.36820 http://www.ativel.com 8B29F6BE: 099D 78BA 2FD3 B014 B08A 7779 75B0 2443 8B29 F6BE [demime 1.01d removed an attachment of type application/pgp-signature which had a name of signature.asc]