# Rectal buttonhole tear during parturition: A case report and literature review

## TL;DR

This paper reports a rare case of a rectal buttonhole tear during childbirth and proposes a new repair technique to prevent complications.

## Contribution

The paper introduces a novel three-layer repair technique for rectal buttonhole tears during parturition.

## Key findings

- A review of 21 reported cases of rectal buttonhole tears showed mostly successful recoveries with multilayer closure.
- A novel three-layer repair technique was successfully used in a case of rectal buttonhole tear with optimal recovery.
- Thorough post-delivery examination is crucial to avoid missing rectal buttonhole tears and prevent long-term complications.

## Abstract

Isolated rectal tears with an intact sphincter lesion are an extremely rare clinical condition during parturition and are often referred to as a“buttonhole tear”.Currently, there is no established protocol for its management.The purpose of this study is to review the published literature of rectal buttonhole tears and describe a novel repair technique used in our case.

All relevant articles were reviewed, including only case reports and case series. Our search identified 21 reported cases, comprising 10 normal vaginal deliveries, 7 operative ventouse deliveries, 4 forceps deliveries, and 1 vaginal breech delivery. All cases had an uneventful recovery except 1. Most authors recommended multilayer closure to reduce the risk of wound dehiscence and fistula formation.

In our case, a 23-year-old primigravida was admitted at 40+6 weeks of gestation. Her pregnancy was uncomplicated except for bacterial vaginosis. A healthy female newborn was delivered without complications. A rectovaginal examination revealed a rectal buttonhole tear with an intact anal sphincter. Following repair using a novel technique and postoperative management, the patient achieved an optimal recovery.

Repair methods for rectal buttonhole tears vary. Given the rarity of this injury, the evidence base is limited. We propose a novel three-layer repair technique assisted by digital rectal support. Importantly, such lesions can be missed without a thorough post-delivery examination, potentially leading to delayed repair and long-term complications like rectovaginal fistula.

The online version contains supplementary material available at 10.1186/s12884-026-08680-7.