Abstract
Background: Vaginal evisceration following a hysterectomy is a very rare condition and it was first reported in the literature in 1864. Small bowel is the commonest organ to prolapse through a ruptured vaginal vault, presenting sometimes as an emergency condition that requires urgent intervention.
Case Report: We report a case of an 86 year old female who presented to the emergency department with small bowel prolapsing through a ruptured vaginal vault, secondary to an acute exacerbation of her chronic cough by a recent chest infection. Following initial resuscitation, the small bowel was successfully reduced using ketamine for sedation. Vaginal repair, which is the definitive treatment, was carried out under spinal anaesthesia. The patient had an uneventful postoperative course; she was discharged home six days after surgery and remains well.
Conclusions: The prolapse was managed successfully though a multidisciplinary team approach. Authors highlight the importance to manage rare and emergency presentations through multidisciplinary team.

Keywords: vaginal evisceration, small bowel prolapse through ruptured vaginal vault, ruptured vaginal vault