Homeland Security Up Your Butt--For Real

| Tue Mar. 27, 2007 5:50 PM PDT

A fistula-in-ano is an abnormal connection between the rectum and skin that can cause pain, bleeding, infections, and discharge of fecal matter through openings in the body other than the anus. The condition is generally caused by infection of a gland within the anal canal. Bacteria multiply and create an abscess that goes through the rectal wall to the surrounding skin. The condition can also be caused by cancer, Crohn's Disease, and an episiotomy that does not heal.

Sue Clark, M.D., a surgeon in Harrow, England, had a patient with fistula-in-ano who had been treated through surgery. The 48-year-old man had a long-term seton to control sepsis. This particular seton was a length of suture material knotted to form a loop placed into the fistula track. Last August, this patient traveled from England to New York for a vacation. Upon arrival, he was interrogated by immigration officials, and then examined and searched. During the rectal exam, an official yanked hard on the seton, causing the patient severe pain. The patient was told he could not enter the United States unless the seton was removed.

Not wanting to give up his vacation after he had flown across the ocean, Dr. Clark's patient allowed a doctor to remove the seton. The physician claimed he had never seen an anal seton before. The good news is that the yanking done by immigration officials did not cause any damage to the sphincter muscles. The bad news is that Dr. Clark's patient must now go under general anastesia to have a new seton inserted.

In a letter to The Lancet last month, Dr. Clark said she wanted to "highlight this rather bizarre manifestation of 'homeland security' in order to warn other patients with setons who travel to the U.S." Former Sen. Carol Mosely Braun talked about Homeland Security's propensity to "look between your toes." Former Texas governor Ann Richards had her crotch checked at the airport. And now an Englishman has had his surgical procedure (not to mention his dignity and his physical comfort) destroyed so that the U.S. can be safe from terrorists.

(Information from the current issue of Harper's, "The Long Arm Of the Law")

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