laparoscopic posterior mesh rectopexy ( lpmr ) is a good surgical option for rectal prolapse with low morbidity and mortality . specific complication like mesh erosion into the rectum following lpmr is very rare with only one such case , in which mesh got expelled via rectum , reported in literature till date . we report a case of mesh erosion into the rectum after lpmr which was managed with laparoscopic mesh removal and review the published literature . a 40-year - old man presented with occasional bleeding per rectum since 10 months with low grade intermittent fever for 1 week . he had history of lpmr for complete rectal prolapse 2 years back , carried out elsewhere . sigmoidoscopy revealed hyperemic mucosa with ulceration 15 cm from anal verge , with a part of the polypropylene mesh projecting into the rectum [ figure 1 ] . computed tomography ( ct ) scan of abdomen showed asymmetric anterior wall thickening of rectosigmoid junction with fat stranding and minimal fluid collection . review of his surgical notes revealed that a 15 cm  10 cm polypropylene mesh was used for rectopexy . since it was a large mesh fixed with multiple tacks and possible dense adhesions , transanal approach was not attempted . under general anesthesia , in lithotomy position , diagnostic laparoscopy was done . appendix was inflamed with its tip densely adherent to the mesh [ figure 2 ] . there was a small rectal perforation at the site of erosion , which was confirmed by air leak test . sigmoidoscopic appearance of mesh erosion into rectum intra - operative images of ( a ) tip of appendix adherent to the mesh and ( b ) mesh eroding into rectum laparoscopic rectopexy is presently the preferred management approach for rectal prolapse as it has better results especially in terms of less post - operative pain , shorter hospital stay , and similar recurrence rate as open rectopexy . it may present with discharge of pus or blood per rectum , even several months or years after surgery . it can be evaluated by doing a flexible sigmoidoscopy , which will usually reveal an ulcerated lesion at the site of erosion with visualization of mesh . ct scan of abdomen with contrast helps in localizing the mesh in relation to rectum as well as pelvic collection , if any . it is less common with type i mesh when compared to type ii , iii , and iv meshes due to bigger pore size with lesser chance of infection . other factors that are found significant are poorly controlled diabetes mellitus , tobacco use , prior history of pelvic irradiation , and repeat procedures , which contribute to poor wound healing and subsequent infection , erosion or extrusion . same causes can be considered as possible etiologies for mesh erosion after lpmr as well . certain surgical technical errors like unrecognized rectal injury and deeper stitches through the rectum may also contribute to mesh erosion . bigger sized mesh which can produce more folding after fixation , as in our case , may be a possible cause for erosion . another possible cause in our case could be infection of mesh due to adhesion of inflamed appendix to it . since , the incidence is very rare , no definite protocol regarding management is available in literature . we preferred laparoscopic approach in our case , as it was too big mesh to remove through transanal approach . moreover , only a part of mesh was protruding into the rectal lumen and it was fixed with multiple tacks to the sacrum . severe inflammation and friable tissues precludes primary repair of the rectal defect where diverting ileostomy or colostomy plays an important role . in summary , the predisposing factors could be mesh infection , larger mesh , and unrecognized rectal injuries . laparoscopic excision of mesh is a feasible and promising approach to manage such an unusual complication following lpmr .