Background: Laceration of the iliac veins and their branches is a feared complication in abdominal sacral colpopexy. Hemorrhages can be extensive and difficult to control. Case: We report a case of a patient who, while undergoing abdominal sacral colpopexy, was found to have confluence of the iliac veins at the level of the second sacral vertebra instead of the expected fourth lumbar to first sacral vertebral bodies. The intraoperative course had to be revised because of the increased risk of bleeding. The patient tolerated the procedure well and without any complications. Conclusion: With pelvic reconstructive surgery becoming more commonplace, knowledge of possible anomalous vessels is important because modification of planned surgical approach may be necessary to avoid short-term and long-term complications.