Background: Injury of the rectum with intact anal sphincter is an extremely rare but very serious complication of vaginal delivery. It is also called a "buttonhole" tear.
Case: We present two cases of "buttonhole" tear/injury.
Results: In one case, the injury was recognized at the time of delivery and adequately treated. In the other case the injury was not diagnosed on time and the patient was treated for complications on the 6th postpartal day.
Conclusion: The consequences for the wellbeing of young mothers with perineal injury can be serious and affect social and sexual aspects of their lives. Adequate surgical treatment and postoperative care assure optimal results and prevent long term complications such as fistulas or fecal incontinence.
Keywords: fourth degree perineal laceration; perineal injury; “buttonhole” tear.