case_images: PMC9624435_01
case_images: Image of the hernia preoperatively.
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case_images: PMC9624435_01_fonc-12-1036145-g001.jpg
case_images: f1
case_images: The bulge could be partly reduced manually but not fully recovered, which suggested perineal hernia accompanied by intestinal adhesions ( Figure 1 ).
case_images: CT view of the hernia.
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case_images: PMC9624435_01_fonc-12-1036145-g002.jpg
case_images: f2
case_images: A contrast-enhanced CT scan confirmed the presence of a perineal hernia and ruled out cancer recurrence ( Figure 2 ).
case_images: The TaTME port, which was equipped with four operating trocars and one observation trocar.
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case_images: PMC9624435_01_fonc-12-1036145-g003.jpg
case_images: f3
case_images: TaTME port, which was equipped with four operating apertures and one observation aperture, was fixed via the wound ( Figure 3 ). The carbon dioxide pneumoperitoneum pressure was set at 12 mmHg.
case_images: Adhesions were released using an ultrasonic knife and an electrocoagulation hook.
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case_images: PMC9624435_01_fonc-12-1036145-g004.jpg
case_images: f4
case_images: Under laparoscopic view, the small intestine was pushed to the cephalic side as much as possible and the adhesions were released using a harmonic  scalpel (Ethicon Inc., Cincinnati, OH, USA) and an electrocoagulation hook ( Figure 4 ).
case_images: Placement of the mesh.
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case_images: PMC9624435_01_fonc-12-1036145-g005.jpg
case_images: f5
case_images: The back of the mesh was sutured to the anococcygeal ligament, the front was sutured to the posterior wall of the vagina, and both sides were sutured to the levator ( Figure 5 ).
case_images: Image of the hernia postoperatively.
case_images: fonc-12-1036145-g006.jpg
case_images: PMC9624435_01_fonc-12-1036145-g006.jpg
case_images: f6
case_images: At the first follow-up examination 4 months postoperatively, the patient reported no obvious bulging and had experienced no symptoms ( Figure 6 ).
case_images: CT view of the hernia postoperatively.
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case_images: PMC9624435_01_fonc-12-1036145-g007.jpg
case_images: f7
case_images: Meanwhile, CT revealed that although there were still bowels falling into the pelvis, the extent was significantly less than before ( Figure 7 ).
case_images: The timeline of this case.
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case_images: PMC9624435_01_fonc-12-1036145-g008.jpg
case_images: f8
case_images: The timeline of this case is showed in  Figure 8 .