Complete rectal prolapse is a distressing condition that represents full-thickness protrusion of the rectum through the anal sphincters mechanism. Incarceration and strangulation of an acute rectal prolapse is a rather unusual entity that represents a surgical emergency. We report a rare case of an 80-year-old woman on antiplatelet drug (Clopidogrel) presenting with acute bowel obstruction secondary to a strangulated loop of small bowel, entrapped in an irreducible bleeding rectal prolapse. She required emergency transperineal small bowel resection and proctosigmoidectomy with colo-anal anastomosis (Altemeier's procedure) followed up by laparoscopic division of adhesions, control of small bowel anastomosis and formation of a defunctioning loop colostomy. The patient had an uneventful post-operative recovery. Since closure of her colostomy five months later her bowel movements are back to normal and she denies any residual incontinence.This case is a very unusual presentation of a complicated acute rectal prolapse dealt successfully with minimally invasive surgical approach that combined perineal bowel resections along with laparoscopy. Emergency procedures tend to have higher rates of post-operative complications as compared to elective ones. Furthermore, with the widen use of more efficient antiplatelet agents such as Clopidogrel, there is an increased risk of encountering early per- or post-operative bleeding that might significantly worsen patients’ outcome. Whenever possible, a planed more ‘conservative’ surgical approach should always be attempted in emergency situations as clearly demonstrated in our case.