Obstetric rectal buttonhole tear and a successful three-layer repair: A case report

Area of Science:

• Obstetrics and Gynecology
• Surgical Repair Techniques
• Perineal Trauma Management

Background:

• Obstetric rectal buttonhole tears (ORBT) are infrequent obstetric complications, with limited documented cases.
• The optimal surgical approach for ORBT repair, specifically two-layer versus three-layer, remains a subject of clinical debate.

Observation:

• This report presents a case of a 26-year-old woman who experienced an ORBT during a spontaneous vaginal delivery.
• The ORBT, along with a third-degree perineal tear, was successfully managed with a detailed three-layer surgical repair technique.

Findings:

• The three-layer repair involved continuous 2-0 Vicryl for rectal mucosa, interrupted 3-0 PDS for vagino-rectal fascia, and end-to-end repair of the external anal sphincter.
• Postoperative recovery was uneventful, with complete wound healing observed over a 12-week follow-up period.

Implications:

• A three-layer repair, including closure of the vagino-rectal fascia, may enhance the tensile strength and improve outcomes for ORBT injuries.
• This case provides valuable clinical lessons for healthcare providers involved in the management of obstetric anal sphincter injuries and rare perineal tears.