homeland security reaches the anus

[Eugen Leitl]

(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 at nwlh.nhs.uk

The Polyposis Registry, St Markbs Hospital, Harrow
HA1 3UJ, UK



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Eugen* Leitl <a href="http://leitl.org">leitl</a> http://leitl.org
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