Table 2.

Case series from Croydon University Hospital

Case number	Mode of delivery	Type of injury	Type of repair	Repair conducted by	Post-operative management	Follow-up and patient symptoms
1	Ventouse	Episiotomy and 4–5 cm of rectovaginal septum, proximal to sphincters	2-layer inverting 2–0 Vicryl. Episiotomy repaired in layers	Colorectal surgeon jointly with obstetrician	5 days antibiotics and Lactulose	Follow-up at 3 months, asymptomatic, endoanal ultrasound normal
2	Forceps, right occiput- posterior	Episiotomy, 3a tear and isolated rectal buttonhole tear	Interrupted 2–0 Vicryl rapide, knots in rectal lumen. 3a tear and episiotomy repaired	Obstetrician	7 days antibiotics, 10 days Lactulose	Follow-up 6 weeks, asymptomatic, endoanal ultrasound normal
3	Forceps, direct occiput-posterior	Episiotomy and 3-cm isolated rectal buttonhole tear	3-layer Interrupted 2–0 Vicryl to mucosa, continuous to muscle (2–0 Vicryl) and vaginal (2–0 Vicryl rapide) mucosa. Re-sutured by consultant	Obstetric trainee (supervised by obstetric consultant)	Vaginal pack, 14 days Lactulose, 3 days antibiotics	Wound breakdown, secondary repair attempted and persistent fistula. Defunctioning ileostomy with further repair