ReviewInternational journal of women's health2025
Obstetric Rectal Buttonhole Tear: Case Series, Literature Review, and Management Recommendations.
Review in International journal of women's health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Characteristics and management of isolated rectal laceration during vaginal delivery.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Purpose: Obstetric rectal buttonhole tear (ORBT) is a rare but serious complication of vaginal delivery, associated with rectovaginal fistula and fecal incontinence. Standardized management protocols are lacking. Patients and Methods: We conducted a retrospective study of 3 institutional ORBT cases (2018-2024) managed with primary transvaginal layered repair and synthesized data from 40 published cases (1993-2024). Results: Among 43 patients, 77.8% were primiparous; the median neonatal weight was 3570 g. ORBT occurred after spontaneous vaginal delivery (58.1%), operative vaginal delivery (34.9%), breech extraction (4.7%), or cesarean section (2.3%). Lateral episiotomy was present in 46.5% of cases, midline in 7.0%. Diagnosis was immediate postpartum (58.1%), during the second stage (34.9%), or delayed (7.0%). Primary transvaginal layered repair was performed in 81.4% of cases with favorable outcomes; colostomy was required in 2.3% after delayed diagnosis. Postoperative antibiotics and laxatives were administered in 86.0% and 72.1%, respectively. Complications occurred in 4.7% (wound dehiscence and rectovaginal fistula). Conclusion: ORBT can occur irrespective of delivery mode, birth weight, or episiotomy but is more frequent in primiparas. Avoidance of rapid descent of the fetal head through the birth canal is recommended. Early diagnosis and primary layered repair by experienced surgeons under anesthesia (with transfer or short delay ≤ 12 h if necessary) optimize outcomes and minimize the need for colostomy. Perioperative antibiotics, structured bowel care, and adequate analgesia are recommended.
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