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Obstetric rectal laceration in the absence of an anal sphincter injury
  1. Adeola Awomolo1,
  2. Danielle Hardman2 and
  3. Adetola Louis-Jacques2
  1. 1Obstetrics and Gynecology, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
  2. 2Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
  1. Correspondence to Dr Adeola Awomolo; awomoloa{at}


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.

  • obstetrics and gynaecology
  • pregnancy
  • surgery

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  • Contributors AA: the primary author participated in the planning of the manuscript, performed the literature review, writing the initial and final drafts of the manuscript. DH participated in obtaining patient consent and images, manuscript writing and revision. AL-J provided a detailed timeline of the case and outcome. AL-J also participated in the writing and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.