A 78 year old woman with a rectal leiomyosarcoma is presented. The case is of interest because of very unusual radiological and operative features of a large rectal diverticulum. As a result of the difficulty in making the correct diagnosis pre- or intraoperatively, a simple, but possibly suboptimal, resection was performed. Although the patient has done well, the long-term outlook is uncertain. The problems of optimum management and prediction of outcome in this uncommon condition are discussed.
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