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Homeland security reaches the anus

Sue Clark, consultant Colorectal Surgeon at St. Mark’s Hospital in Harrow, UK, writes in The Lancet (vol. 369, February 3, 2007, p. 370):

homelandSecurity.jpgHomeland 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….

On arrival in New York in August, 2006, for a holiday… 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.

(Thanks to investigator Kristine Danowski for bringing this to our attention.)

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