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Obstetric rectal laceration in the absence of an anal sphincter injury

Adeola Awomolo1, Danielle Hardman2, Adetola Louis-Jacques2

  • 1Obstetrics and Gynecology, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA awomoloa@obgyn.arizona.edu.

BMJ Case Reports
|August 7, 2021
PubMed

Rectal laceration in the absence of concurrent anal sphincter injury at the time of parturition is not a frequently reported finding. This rarely encountered injury is also referred to as a buttonhole injury. It is a disruption of the vaginal and rectal tissue with resultant disruption of the anal epithelium in the setting of an intact external anal sphincter. A 30-year-old gravida 1 para 0 at 39 weeks presented for induction of labour due to chronic hypertension. During her labour course, she developed with superimposed preeclampsia with severe features and magnesium sulfate was initiated. She underwent a spontaneous vaginal delivery of an infant weighing 3840 g. Following delivery, stool was visualised in the vagina. A rectal examination revealed a rectovaginal defect separate from the second-degree perineal laceration, which extended proximally to the cervix. The anal sphincter was noted to be intact with good tone. Both defects were repaired, and she had an uncomplicated recovery.

Keywords:
obstetrics and gynaecologypregnancysurgery

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