Obstetric Rectal Buttonhole Tears: A Case Series and Literature review

INTRODUCTION

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

METHODS

A literature review was carried out. All results were reviewed. Rectal buttonhole tears following vaginal delivery between 2012 and May 2022 in our institution were identified. Repair technique and post-operative 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 six weeks. One woman had a defunctioning stoma following a wound breakdown and one woman was readmitted with a rectal haemorrhage. 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 suffer no short-term morbidity following these injuries. This review adds to the current literature with examples of different repair techniques and outcomes.