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Homeland Security plumbs new depths

The Lancet 2007; 369:370 Correspondence
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.

[Thanks Tim Chapman! Warning – Not for the faint of heart!]

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
Crohn’s 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
“homeland security” 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.”

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9 Responses to Homeland Security plumbs new depths

  1. David says:

    It’s fairly obvious that they need Homeland Security doctors with more experience or the ability to call upon other doctors before making statements that they don’t know anything about.

  2. Andrew says:

    Actually, David, I think it is fairly obvious that Homeland Security is a farce that does nothing but provide the illusion of safety while inconveniencing, humiliating, and often endangering legitimate travellers.

  3. Mark says:

    Having recently made a return trip to San Francisco, I’d have to agree with you Andrew. After queuing for some time, then having to ditch water bottles and cram my camera bag into my carry on, when your things do finally go through the X-ray machine, there’s one *very* tired-looking woman glancing at the monitor with no-one on hand to provide a second opinion. I really don’t know how secure the process is at all.

  4. Ruth says:

    Poor guy!!! Its probably quite possible that this “doctor” was just a general practitioner. I say this as I too suffer from crohns disease and I too have had anal setons fitted and my GP didn’t know what they were either. For anyone out there that hasn’t had fistulas, mark my words they are excrutiating. It wouldn’t have taken much effort for this doctor to check with someone who would have known what a seton is. I can imagine how much pain this chap was in and to think he had to have the seton removed as well. Not only was he under suspicion but he will probably have suffered a set back in the treatment of his fistulas through this doctors ignorance. I do hope he’s ok now.

  5. SJV says:

    Egads! Homeland Insecurity more like. I know there’s problems with terrorism, but that’s just going too damn far. Never had setons, since my fistula was far enough away from the bowel that they could just cut it out, but I think I woulda been trying to find some representation at that point. That’s rediculous! What’s next, denying someone entrance into the country because they have something under the skin attached to their heart? Or how bout denying someone entrance for the metal plate in their head. Hey, maybe there’s something bad in that stoma we don’t know about.

    Get me off this rock…

  6. Jack says:

    A patient arrives in New York, probably after flying for six hours across the Atlantic without incident, and then he was threatened with refusal of entry by those botchers of Homeland Security officers, not to mention this incompetence of a veterinarian? Or take the no-fly list debacle. When are these cases going to have serious consequences for the wrongdoers? What comes next, direct-flight to camp X-Ray?

  7. matt says:

    No, from New York it’s a private flight to Syria via Italy, followed by a year of torture (see Maher Arar).

  8. THE VETERAN says:

    I don’t have any intention of belittling anyone’s health problems here however, I couldn’t help butt(pun?) thinking that, if this was “billo” from fox noize and they pulled the string, would his mouth move and automatically lie?

    This “horrorland insecurity” has everything it touches totally screwed up.

  9. Nancy says:

    What a play on words

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