SummaryTwo cases of leiomyosarcoma of the rectum are reported. One patient died of local extension and distant metastases. In the other patient the disease was palliated by cryosurgery to relieve obstruction and, eight months later, the patient was doing well.Medical literature has been reviewed. Leiomyosarcoma of the rectum is rare and extremely malignant. Ninety‐seven cases are reported in medical literature; the five‐year survival rate was 20 to 25 per cent. Invariably, local excision is followed by local recurrence. The treatment of choice is abdominoperineal resection but, even with this method, the survival rate is poor.