Evisceration of the small intestine through the vaginal cuff is a rare surgical entity scarcely reported in literature with a high risk of strangulation and necrosis of the prolapsed bowel. We report the case of an evisceration of the small intestine through the vaginal cuff in a 75 years old female patient with a medical history of total hysterectomy for uterine prolapse and fibroids. Successful reintegration of the prolapsed bowel and repairing of the vaginal defect were carried. Early diagnosis and timely surgical intervention are justified by the high potential of complications. In case of doubts about the viability of the bowel or if transvaginal reduction is not possible, a combined transabdominal approach should be used.