The Authors report a case of recurrent leiomyoma of the rectum treated by Transanal Endoscopic Microsurgery (T.E.M.). Leiomyoma of the rectum is a rare entity (0.1-0.3%) (the incidence of smooth muscle tumours being 7% in the digestive tract). Benign leiomyomas are usually asymptomatic; discomfort or pain, related or not to defecation, sensation of foreign body, change in bowel habits, rectal bleeding are rarely reported. The distinction between a benign leiomyoma and a leiomyosarcoma is often difficult and requires an accurate microscopic study. In most cases rectal leiomyoma is detected incidentally in the course of a rectal examination. Endoscopic examination of the rectum with biopsies and endorectal ultrasonography are useful for the diagnosis, while rarely a plain radiologic examination is sufficient. Leiomyoma of the rectum also presents a high tendency to local recurrence (31%). Therefore the choice of an adequate treatment is often difficult. The Authors believe that the treatment of rectal leiomyoma by T.E.M. may substitute conventional methodics (transanal excision, proctectomy with or without amputation of the sphincter and coloanal anastomosis, endoscopic electroexcision of the neoplasm). T.E.M. allows short-term hospitalization and implies minimal surgical trauma.