Introduction and Hypothesis <p>Vaginal vault dehiscence with evisceration is a rare but severe complication following pelvic reconstructive surgery. Late presentations after sacrospinous ligament fixation (SSLF) are particularly uncommon. We report a rare case of late vaginal vault dehiscence with omental evisceration in a menopausal patient 2 years after SSLF, along with a structured review of the literature.</p> Methods <p>A 65-year-old menopausal woman presented with acute pelvic pain and vaginal protrusion of omental tissue 13 years after a vaginal hysterectomy and 2 years after SSLF. Examination revealed a 2-cm vaginal cuff defect with omental evisceration. She underwent urgent transvaginal surgery, including partial omentectomy, reduction of viable tissue, vaginal cuff repair, and McCall culdoplasty. </p> Results <p>Recovery was uneventful.</p> Conclusions <p>Late vaginal vault dehiscence after SSLF is rare but should be considered a surgical emergency. Our accompanying literature review highlights the spectrum of delayed presentations, common triggers, and management strategies, emphasizing the need for long-term surveillance. Isolated omental evisceration may represent a precursor phase of vault failure before bowel involvement. Prompt diagnosis and management are essential to prevent progression to bowel involvement and associated morbidity.</p>