AB003. SOH23ABS_079. Obstetric rectal buttonhole tears: a case series and literature review

Background: Isolated rectal buttonhole tears are a rare obstetric complication and so there is a lack of consensus for their management. This case series reviews the published literature on obstetric rectal buttonhole injuries and provides further cases from our institution.

Methods: A literature review was carried out. All results were reviewed. Rectal buttonhole tears following vaginal delivery between 2012 and May 2022 in our institution were identified. Repair technique and post-operative management were recorded.

Results: There were 14 published case reports. Seven case reports described a two-layer closure, and seven reports described a three-layer closure. Four cases were repaired in collaboration with colorectal surgeons. Twelve cases were asymptomatic after six weeks. One woman had a de-functioning stoma following a wound breakdown and one woman was readmitted with a rectal haemorrhage. We identified two women in our institution with buttonhole tears. Three-layer repairs were performed in both cases and each woman made an uneventful recovery.

Conclusions: Repair techniques of rectal buttonhole tears vary among institutions. Despite this variance, most women suffer no short-term morbidity following these injuries. This review adds to the current literature with examples of different repair techniques and outcomes.

Keywords: Isolated rectal buttonhole tear; rectovaginal fistula; obstetric anal sphincter injury; third and fourth degree tears; rectal examination