The patient had recurrence of ovarian cancer after post-operative chemotherapy and then radical surgery Henan Cancer Hospital, Department of General Surgery Wang Gangcheng The patient, 52 years old, had recurrence of ovarian cancer after post-operative chemotherapy and tumor progression after chemotherapy again. The abdomen was soft, the tumor could be palpated by rectal palpation and vaginal stump palpation, and the anterior vaginal wall was 5 cm normal. Today, in the dissection, there was no tumor in the upper abdomen, and the tumor was located in the pelvic cavity invading the rectovaginal stump, which was closely related to the right pelvic wall. Rectosigmoid resection (Dixon procedure) + vaginal stump resection + ileostomy was performed. Intraoperative points: 1. separation of the vaginal stump, usually peeled or cut with scissors with sensation, should not split the posterior bladder wall. 2. left hand into the vagina as a guide to avoid separation of the wrong layer. 3. prevention of leakage of the vesico-vaginal stump. Vesico-vaginal stump leakage may occur due to postoperative chemotherapy and adhesions to the posterior bladder wall that become thin after separation. If the patient has a large omentum, the large omentum is available, but in this patient the large omentum was excised. In this patient, the splenic flexure colon was freed and the wide colonic mesentery did not need to be excised. The excess colonic mesentery was sewn to the vaginal stump to enhance the posterior bladder wall to isolate the vesicovaginal space and prevent vesicovaginal leakage. Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital Figure 1 Preoperative pelvic CT Figure 2 Intraoperative showing vaginal stump and tumor Figure 3 After tumor resection, vaginal stump with clean tumor Figure 4 Sutured vaginal stump Figure 5 Free greater omentum, prepared for intestinal anastomosis Figure 6 After rectocolonic anastomosis, sutured to posterior bladder wall with colonic mesentery Figure 7 Specimen after resection, vaginal stump and rectum