Surgical correction of pelvic organ prolapse is increasingly common. The vaginal approach is often favored secondary to its limited peritoneal cavity access and low complication rates. A thorough review of the literature revealed no previous reports of primary vaginal reconstructive surgery leading to small bowel obstruction (SBO). Three patients who underwent transvaginal hysterectomy, uterosacral ligament vaginal vault suspension, and other reconstructive procedures subsequently suffered from SBO. All patients failed conservative management and required surgery. All were treated with laparoscopy initially, but two patients required laparotomy to correct iatrogenic enterotomies. The complication of SBO should be considered in the post vaginal surgery patient with abdominal pain. Though laparoscopic surgery can be considered, our experience has been discouraging. Candidate selection is critical and care should be taken to avoid enterotomy.