A 55-year-old woman had a PPH performed for rectal internal mucosal prolapse and rectocele. After surgery she continued to suffer from mucosal prolapse and obstructed defecation. In an attempt to remove the prolapse a second PPH was perfomed 2 years later. This was complicated by rectal lumen obliteration which was treated by a low anterior resection. Four years later she continued to have evacuatory disorders and proctalgia. On exam she was found to have a 5 cm deep rectal diverticulum with entrapped fecaliths at what appeared to be the site of the first PPH (Fig.1). She underwent laying open and marsupialization of the diverticulum with removal of several retained staples (Fig. 2). The patient is symptom-free 6 months after surgery.

Fig. 1
figure 1

The rectal diverticulum probed by a 16 mm Hegar dilator

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Fig. 2
figure 2

The pocket is being laid open

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