The procedure for prolapsed hemorrhoids (PPH) is associated with low levels of postoperative pain but may be followed by unusual and severe postoperative complications.

We report a case of a 62-year-old woman affected by tenesmus, obstructed defecation and vaginal bulging 2 years after a PPH procedure performed in another institution. Clinical examination and colonoscopy revealed a mass within the anterior rectal wall bulging into the vaginal and rectum lumen 3 cm above the dental line, mimicking a stromal tumor.

Magnetic resonance imaging (MRI) confirmed the presence of an avascular mass, 4 cm in diameter, confined to the anterior rectal wall (Figs. 1, 2).

Fig. 1
figure 1

Coronal MRI revealed a mass within the rectal wall (big arrow) deforming the rectal lumen (small arrow)

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Fig. 2
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Sagittal MRI showed the mass was enclosed in rectal mucosa at the level of the rectovaginal septum

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Intraoperative findings revealed a calcified fecaloma enclosed in a mucousal rectal diverticulum communicating with the rectal lumen with a little opening at the level of the staple line (Figs. 3, 4).

Fig. 3
figure 3

The opened mucosa (arrow) with a finger in rectal lumen

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Fig. 4
figure 4

Fecaloma removed from the mucosal rectal diverticulum

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