Perineal hernia is a recognized but uncommon complication following proctectomy. Emergency presentations of this hernia are very rare and are not well described in the literature. We present the case of an 81-year-old lady who presented with small bowel obstruction with strangulation secondary to a perineal hernia 2 years after abdominoperineal resection for carcinoma of the rectum. At laparotomy, a small bowel resection was required and a biological mesh was used to repair the perineal defect.
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