Abstract: A 25-year-old female came with a complaint of epigastric pain for a year with soft, non-tender abdomen and per rectally, a fluctuant cystic extrinsic swelling behind the rectal wall was found. Ultrasonography revealed cholelithiasis along with a well-defined, heterogenous echotexture mass of 68*45 mm lying posterior to the urethra. CECT abdomen (fig 1) showed a well-defined, predominantly hypoechoic lesion with foci of calcification in its wall in the right ischio-rectal fossa region extending up to tip of the coccyx inferiorly, levator ani muscle superiorly and external anal sphincter medially.
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