Introduction: Colorectal cancer (CRC) is the third most common cancer in Australia. Locoregional recurrence (LR) affects 4-11.5% of patients following curative resection and over 50% of these occur at the anastomosis or peritoneally. We describe a rare case of metachronous intramural (IM) metastasis within the rectum from a right colon cancer two years following curative resection. Case: A 62-year-old male was reviewed in clinic with a rising carcinoembryonic antigen level two years after right hemicolectomy and adjuvant FOLFOX chemotherapy for T4aN1a adenocarcinoma of the ascending colon with clear margins. Subsequent CT and colonoscopy showed no mucosal lesion but MRI and PET suggested a suspicious mass in the upper rectum. He proceeded to have a laparoscopic anterior resection with histopathology showing two IM nodules of adenocarcinoma up to 2cm in size within the muscularis propria 5cm apart, with no mucosal or lymph node involvement. One nodule had serosal involvement. They were considered recurrences because of morphological and immunophenotypical similarity to the ascending colon cancer two years prior. Discussion: Involvement of the serosa in one nodule suggests LR in the peritoneum and adjacent rectum secondary to ‘drop metastasis’. The presence of a second nodule 5cm apart within the muscularis propria, without serosal involvement suggests IM spread, a known phenomenon in upper gastrointestinal cancers but rarely seen in CRC. There have been few reports of IM metastasis of primary rectal cancer but none from a primary lesion in the right colon. Conclusion: Close multi-modal surveillance post curative resection of CRC and multidisciplinary approach is recommended for early detection of LR.