Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital aplasia of the uterus and upper part of the vagina in females. Treatment includes surgical creation of a functional neovagina. Perforation of the neovagina is extremely rare with only handful of cases reported in transgender patients post gender reassignment surgery. We report a first case of sigmoid neovaginal perforation in MRKS patient. The patient presented with progressively worsen abdominal pain and multiple intra-abdominal abscesses due to perforation of sigmoid neovagina. She was treated with surgical drainage and antibiotics and recovered clinically. Although exceedingly rare, we should keep history of sigmoid neovaginoplasty and possible perforation in patients with MRKS presenting with abdominal abscesses.