Obstetric Rectal Buttonhole Tear: Case Series, Literature Review, and Management Recommendations
Junhua Tang1, Dongmei Fu1, Xiaohong Wang1
1Department of Gynecology and Obstetrics, Beijing Daxing Maternal and Child Care Hospital, Beijing, People's Republic of China.
International Journal of Women'S Health
|December 1, 2025
Summary
Obstetric rectal buttonhole tears (ORBT) are rare vaginal delivery complications. Early diagnosis and layered repair by experienced surgeons improve outcomes and minimize colostomy needs.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Maternal-Fetal Medicine
Background:
- Obstetric rectal buttonhole tear (ORBT) is a rare but serious complication of vaginal delivery.
- It is associated with rectovaginal fistula and fecal incontinence, and standardized management protocols are lacking.
Purpose of the Study:
- To review the management and outcomes of obstetric rectal buttonhole tears (ORBT).
- To identify factors influencing outcomes and provide recommendations for standardized management.
Main Methods:
- Retrospective review of 3 institutional ORBT cases (2018-2024).
- Synthesis of data from 40 published ORBT cases (1993-2024).
- Analysis of delivery modes, neonatal weights, episiotomy use, diagnosis timing, and management strategies.
Main Results:
- ORBT occurred in 43 patients, predominantly primiparous (77.8%), with a median neonatal weight of 3570g.
- Primary transvaginal layered repair was successful in 81.4% of cases; colostomy was needed in 2.3% after delayed diagnosis.
- Complications included wound dehiscence and rectovaginal fistula in 4.7% of cases.
Conclusions:
- ORBT can occur regardless of delivery mode, birth weight, or episiotomy, but is more common in primiparas.
- Early diagnosis and primary layered repair by experienced surgeons optimize outcomes.
- Perioperative antibiotics, structured bowel care, and analgesia are recommended.
More Related Videos
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
428
Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
Here are some common surgical interventions for IBD:
428
01:28Esophageal Perforation-II: Clinical Manifestations and Management
467
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
467
01:25Assessment of the Rectum and Anus
1.0K
Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
1.0K