BackgroundRupture of the vaginal vault followed by evisceration of bowel through the vagina is a rare complication after hysterectomy and an unforgettable experience for the physicians involved.CaseA 59-year-old white woman underwent abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy for endometrial adenocarcinoma International Federation of Gynecology and Obstetrics Stage IIA grade 3. Three high-dose-rate brachytherapy vaginal insertions with iridium were done 5, 6, and 7 weeks postoperatively. Thirteen days after the third insertion, she presented with a pinkish vaginal discharge, a 4-cm rupture in the vaginal vault, and small bowel loops prolapsed into the vagina. A vaginal repair was done.ConclusionThis is the first reported case of vaginal evisceration related to iatrogenic trauma at high-dose-rate brachytherapy insertion. Prompt surgical treatment can minimize complications.