EJMCR |

Case Report

Published: Dec 10, 2025 | DOI: 10.24911/ejmcr.9-2395

Episiotomy complicated by rectal injury: a detailed case report

Authors: Ghadeer Alenezi , Meshaal Alenezi , Omar Yousef , Ahmed Osman , Nabil Riyad , Mohammad AlJasmi

Article Info

Authors

Ghadeer Alenezi

Maternity Hospital, Kuwait City, Kuwait

Meshaal Alenezi

Al-Jahra New Hospital, Kuwait City, Kuwait

Omar Yousef

Al-Jahra New Hospital, Kuwait City, Kuwait

Ahmed Osman

Al-Jahra New Hospital, Kuwait City, Kuwait

Nabil Riyad

Al-Jahra New Hospital, Kuwait City, Kuwait

Mohammad AlJasmi

Al-Jahra New Hospital, Kuwait City, Kuwait

Publication History

Received: October 20, 2025

Accepted: November 15, 2025

Published: December 10, 2025

Abstract

Background:
Episiotomy, a perineal incision during labor to facilitate vaginal delivery, is now selectively used in instrumental births like vacuum-assisted procedures to lessen severe perineal trauma, though it risks rare extensions into the rectal wall. Such full-thickness rectal tears, classified as fourth-degree injuries, occur more commonly with midline incisions and can lead to fecal incontinence, pain, or sepsis if not addressed swiftly.
Case Presentation:
A 32-year-old woman with an unremarkable prenatal history underwent vacuum-assisted vaginal delivery complicated by a mediolateral episiotomy extending to a full-thickness anterior rectal tear 10 cm from the anal verge. She presented hemodynamically stable with perineal pain, bleeding, and stool spillage; digital exam confirmed the injury without soiling. Under anesthesia, a triple-layer closure was used with absorbable sutures for mucosa, muscularis, and serosa, avoiding colostomy. Broad-spectrum antibiotics continued for two weeks, with nil per os for 48 hours followed by enteral feeding. Postoperative monitoring showed no infection or incontinence; discharge occurred on day 10. Follow-up MRIs at six weeks and six months revealed intact rectal integrity and normal sphincter function, with pelvic exercises aiding recovery.
Conclusion:
This case demonstrates that timely recognition and layered repair of rectal tears after episiotomy can achieve excellent functional outcomes without the need for diversion colostomy.

Keywords: Episiotomy, rectal tear, fourth-degree perineal injury, vacuum-assisted delivery, triple-layer repair, case report.

Pubmed Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi. Episiotomy complicated by rectal injury: a detailed case report. EJMCR. 2025; 10 (December 2025): -. doi:10.24911/ejmcr.9-2395

Web Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi. Episiotomy complicated by rectal injury: a detailed case report. https://ejmcr.com/articles/2395 [Access: December 16, 2025]. doi:10.24911/ejmcr.9-2395

AMA (American Medical Association) Style

Vancouver/ICMJE Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi. Episiotomy complicated by rectal injury: a detailed case report. EJMCR. (2025), [cited December 16, 2025]; 10 (December 2025): -. doi:10.24911/ejmcr.9-2395

Harvard Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi (2025) Episiotomy complicated by rectal injury: a detailed case report. EJMCR, 10 (December 2025): -. doi:10.24911/ejmcr.9-2395

Chicago Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi. "Episiotomy complicated by rectal injury: a detailed case report." 10 (2025), -. doi:10.24911/ejmcr.9-2395

MLA (The Modern Language Association) Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi. "Episiotomy complicated by rectal injury: a detailed case report." 10.December 2025 (2025), -. Print. doi:10.24911/ejmcr.9-2395

APA (American Psychological Association) Style

Ghadeer Alenezi, Meshaal Alenezi, Omar Yousef, Ahmed Osman, Nabil Riyad, Mohammad AlJasmi (2025) Episiotomy complicated by rectal injury: a detailed case report. , 10 (December 2025), -. doi:10.24911/ejmcr.9-2395