Secondary perineal herniation of intraperitoneal contents represents a rare complication following procedures such as abdominoperineal rectal resection or cystectomy. We present a case of a perineal hernia formation with prolapse of an ileum neobladder following radical cystectomy and rectal resection for recurrent bladder cancer. Following consecutive resections in the anterior and posterior compartment of the lesser pelvis, the patient developed problems emptying his neobladder. Clinical examination and computed tomography revealed perineal herniation of his neobladder through the pelvic floor. Through a perineal approach, the hernial sac could be repositioned, and via a combination of absorbable and non-absorbable synthetic mesh grafts, the pelvic floor was stabilised. Follow-up review at one year after hernia fixation showed no signs of recurrence and no symptoms.In cases of extensive surgery in the lesser pelvis with associated weakness of the pelvic compartments, meshes should be considered for closure of the pelvic floor. Development of biological meshes with reduced risk of infection might be an interesting treatment option in these cases. KEYWORDSPerineal hernia -Bladder cancer -Rectal resection -Mesh -Colorectal Accepted 4 October 2015; published online XXX CORRESPONDENCE TO Emile Rijcken, E: rijcken@uni-muenster.de Secondary perineal herniation of intraperitoneal contents represents a rare complication following procedures such as abdominoperineal rectal resection (APRR) or cystectomy and occurs in about 0.62-3.5% of cases.1,2 Risk factors include insufficient closure of the peritoneum or pelvic floor, extended resections, (neo)adjuvant radio/chemotherapy, smoking, wound infections, obesity, wound dehiscence and female sex.1 Symptoms may vary from an uncomfortable perineal feeling, to a newly appearing perineal protrusion or pain and they can also include changes in urinary or bowel function. Treatment depends on the symptoms and can range from conservative treatment to perineal, abdominal or abdominoperineal reoperation.3,4 We describe the rare case of a 61-year-old man who presented with herniation of an ileal neobladder following extensive surgery for recurrent urinary carcinoma. Case historyA 61-year-old man underwent combined prostate and bladder resection for bladder cancer in 2009 (pT3b, pN0, M0, L1, V1, R0, G3). The orthotopic neobladder was reconstructed with an ileum segment and four series of adjuvant chemotherapy were administered. No residual tumour was left and oncological follow-up was uneventful for the next two years. In 2011 eight additional series of chemotherapy were administered for local recurrence in the lesser pelvis with ventral compression of the rectal wall (Fig 1). After good response, another surgical approach was attempted to remove the remaining tumour (Fig 2). APRR was performed with primary closure of the perineal cavity. The pelvic floor was reconstructed by direct suture of the levator muscles, omentum was used for abdominal closure of the lesser pelvis and a...

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