Introduction:
A rectocele is a hernation of the rectum into the vaginal lumen developing as a consequence of weakness of the rectovaginal septum. It affects about 18% of women after childbearing age. Symptoms associated with a rectocele include constipation, vaginal fullness or heaviness, feeling of a bulging mass within vagina, incomplete stool evacuation and dyspareunia. Current methods of surgical treatment of a rectocele often require implantation of a mesh graft. In most of cases, synthetic and non-absorbable meshes are used. Although implantation of a synthetic and non-absorbable mesh is effective in the treatment of rectocele, a high rate of mesh erosion has been reported.

Case report:
This study presents a surgical technique and case report for the treatment of a rectocele in a 46-year-old women by implantation of a porcine-derived absorbable collagen mesh (Pelvicol®) by transvaginal approach, with six year follow-up. A review of the literature concerning implantation of Pelvicol® for the treatment of rectocele was also undertaken.

Conclusions:
The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.