Transvaginal small bowel evisceration is a rare, life-threatening condition, requiring urgent surgical intervention. In our case, ischemiadeveloped in the intestinal segment with evisceration, with a laceration in the small intestine of the mesentery, and finally, a small bowelresection was required. An 89-year-old woman was brought to the hospital with a sudden onset of abdominal pain, which lasted for 4hours. Upon the examination, it was found that approximately 50 cm of the small intestine was eviscerated from the vagina, with itsmesentery. The intestines were edematous, and also there were signs of ischemia on the mesentery. The patient was urgently transferred to surgery. Functional end-to-end anastomosis was performed, following a 70 cm small bowel resection. The vaginal defect wasrepaired transvaginally. Transvaginal small bowel evisceration is rarely described in the literature. It is most commonly seen in postmenopausal, elderly women who underwent vaginal surgery before and who have enterocele. The treatment is an emergent surgicalapproach. Surgical treatment should be based on individual patient. Various surgical techniques have been described for the repair oftransvaginal small bowel evisceration, such as vaginal, abdominal, laparoscopic, and combined approaches. Transvaginal small bowel evisceration should be considered in the differential diagnosis of patients with a sudden onset abdominal pain. Patients with an increasedrisk for transvaginal small bowel evisceration are postmenopausal women and patients who underwent vaginal surgery before. Afterthe accurate diagnosis, patients should be operated as soon as possible, and necessary surgery should be done.