Intestinal intussusception is a relatively uncommon occurrence in adults in comparison to pediatric patients. While the management of intussusception in children is frequently decompression of the involved segment, adults often require surgical resection secondary to frequent association with neoplastic lead points. A less common reason for surgical removal of an intussuscepted segment in adults is the development of ischemic colitis. The authors present an unusual case of adult intussusception with associated ischemic colitis in a patient with portal hypertension awaiting liver transplantation. Portal hypertension is associated with the development of a microvascular colopathy This condition may serve as the lead point for intestinal intussusception. Furthermore, the vascular changes of portal hypertension leave the bowel unable to respond appropriately to the threat of ischemia. The colopathy of portal hypertension may have predisposed our patient to the development of colonic intussusception by submucosal vascular engorgement; it may have also rendered the intussuscepted segment more susceptible to the development of ischemia.