We present a case of an elderly man with what appeared to be an episode of rectal prolapse following straining while defaecating. Laparotomy revealed the prolapse to be an intussusception of large bowel with a villous adenoma as its lead point. Reduction resection was performed with primary anastomosis, and the patient recovered well from the surgery. Rectal prolapse has often been viewed as a benign condition in the elderly, but more thought needs to be put into the diagnosis in patients with risks of malignancy. Prolapse of an intussuscepted bowel segment in adults is an exceedingly rare presentation, often signifying a risk of malignancy. Appropriate investigations and surgical techniques need to be employed in effectively resolving symptoms while minimising the chances of tumour seeding.