Perineal hernias can occur primarily or secondary to a pelvic operation. Among primary perineal hernias, the congenital type is very rare, with less than 10 cases reported in the literature. This is a case report of a healthy female child presenting with a congenital posterior perineal hernia who underwent successful delayed operative repair using a perineal approach. Level of evidence: Level V – case report. Keywords: Perineal hernia, Pelvic hernia, Congenital, Rare hernia, Rectal hernia