In this paper, we describe a small-bowel vaginal evisceration occurring 4.5 months following total abdominal hysterectomy. We also report current opinion and treatment of this possibly under-reported complication. Vaginal evisceration is an important and underestimated complication of hysterectomy. A recent retrospective study showed an incidence of 0.28% in women following hysterectomy. In this paper, we describe a 66-year-old woman who presented to our emergency department with a small-bowel vaginal evisceration 4.5 months after she had undergone a total abdominal hysterectomy. We also present an updated review of current thinking on vaginal evisceration and propose risk factors and methods of treatment for this condition.