Two cases of stricture of the mid-rectum following extensive pelvic cellulitis due to the use of an intra-uterine contraceptive device (IUCD) are presented. The resulting dense circumferential extrarectal strictures failed to respond to treatment by proximal colostomy and antibiotic therapy and required difficult corrective resection. These are contrasted with an example of the more common upper rectal strictures associated with intraperitoneal sepsis of gynaecological origin, in this case pyosalpynx. Circumferential and transmural spread of inflammation tends to be limited by peritoneal reaction and the resulting strictures (which may be radiologically as severe as those in the mid-rectum) are often readily managed by simple removal of the source of infection. Thus, it appears that simple anatomical factors may be responsible for the differing pathologies seen in the two sites, and different management problems encountered within the two types of strictures.