Evisceration of small bowel through the rectum is extremely uncommon, chronic long standing prolapse and/or increased intra-abdominal pressure being the most frequent association. Management is in line of any acute abdomen with resuscitation beginning as soon as patient arrives with covering the bowel with moist hot packs. The management of such patients depends on the general state of each individual patient. In extremely frail patients, palliative care should be instituted. Laparotomy and Hartmann's procedure is the safest option. Here we report a case of an elderly female with full-thickness chronic rectal prolapse who presented acutely at the Emergency Department with small bowel eviscerating through the anus following it herniating through the rectum.