A 73-year-old woman with stress urinary incontinence and uterine prolapse underwent vaginal hysterectomy followed by tension-free vaginal tape (TVT) placement. Postoperatively, she presented with low-grade fever and abdominal distension. Abdominal computed tomography revealed bowel distension and abrupt cutoff of the distended small bowel and normal bowel caliber. Transperitoneal laparotomy demonstrated perforation of the mesentery by the TVT without other injury. The tape was cut in its intraperitoneal portion. The patient resumed normal bowel function and, at last follow-up, remained continent. We advocate that when performing TVT placement in conjunction with vaginal hysterectomy, TVT placement should be performed at the beginning of the procedure.