Obstetric rectal buttonhole tears: A case series and literature review

Abstract

Introduction: Isolated rectal buttonhole tears are a rare obstetric complication and so there is a lack of consensus for their management. The current case series reviews the published literature on obstetric rectal buttonhole injuries and provides further cases from our institution.

Methods: A literature review was performed and all results were reviewed. Rectal buttonhole tears following vaginal delivery between 2012 and 2022 in our institution were identified. Repair technique and postoperative management were recorded.

Results: There were 14 published case reports. Seven case reports described a two-layer closure, and seven reports described a three-layer closure. Four cases were repaired in collaboration with colorectal surgeons. Twelve cases were asymptomatic after 6 weeks. One woman had a defunctioning stoma following a wound breakdown and one woman was readmitted with a rectal hemorrhage. We identified two women in our institution with buttonhole tears. Three-layer repairs were performed in both cases and each woman made an uneventful recovery.

Conclusion: Repair techniques of rectal buttonhole tears vary among institutions. Despite this variance, most women experience no short-term morbidity following these injuries. This review adds to the current literature with examples of different repair techniques and outcomes.

Keywords: isolated rectal buttonhole tear; obstetric anal sphincter injury; rectal examination; rectovaginal fistula; third- and fourth-degree tears.