An 86-year-old female presented with the first episode of an incarcerated full thickness rectal prolapse, concerning for ischemia of the prolapsed segment. Intra-operatively, the patient was noted to have an enterocele containing a 20-25 cm segment of strangulated and perforated small bowel. She underwent a perineal rectosigmoidectomy (altemeier procedure) with levatorplasty followed by a small bowel resection and anastomosis trans-abdominally.