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The patient received postoperative radiation followed by gemcitabine (100 g/m^2^ on days 1, 8, 15) and cisplatin (70 mg/ m^2^ on day 2) for a 28-day cycle for six months, but he died eight months later due to disseminated peritoneal carcinomatosis.

Discussion {#sec1-3}
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RLP secondary to urinary bladder carcinoma is very rare \[[@ref5],[@ref6]\]. Dressen et al described two patients who presented with changed bowel habits \[[@ref5]\]. All diagnostic tests were inconclusive. In both patients pelvic MRI images revealed double-layered thickening of the rectal wall with an inner iso-intense circumferential thickening of the submucosal and hypo-intense circumferential thickening of the muscular rectal wall and a thickened bladder wall. Surgery disclosed a grade III papillary transitional cell carcinoma with infiltration of rectal wall and prostate gland in the first patient. In the second patient the RLP was due to recurrent transitional cell carcinoma of the urinary bladder. Gleeson et al described the EUS features and tissue diagnosis of secondary RLP in three patients with recurrent urinary bladder cancer \[[@ref6]\].

Our patient was asymptomatic from the urinary tract and secondary RLP was caused by hematogenous spread of a small urinary bladder carcinoma. Our inability to establish a preoperative diagnosis, despite the fact that endoscopic and endorectal pictures were compatible with RLP, is quite common. There is usually a long delay between the onset of symptoms and final diagnosis \[[@ref5]-[@ref7]\], caused by the fact that RLP can mimic various diseases such as inflammatory bowel disease, stenosis related to diverticulosis, ischemia, radiation-induced strictures, solitary rectal ulcer, endometriosis and malignant lymphoma \[[@ref1],[@ref8]-[@ref11]\]. Moreover, mucosal biopsies are rarely positive, as in our case, because the disease is predominantly located in the submucosal and muscularis propria. With the advent of interventional endosonography, EUS-guided fine needle aspiration i