Hidden in plain sight: abdominopelvic pain unveiling a Spigelian hernia containing ovary and fallopian tube

Spigelian hernias are rare clinical entities; vague symptomatology and unreliable clinical examination ensure difficult diagnosis. Computed tomography (CT) is critical for accurate diagnosis. Surgical repair is mandated given the high risk of visceral organ incarceration. Few cases have reported herniation of the ovary or fallopian tube. A 76-year-old female presented with bilateral lower quadrant pain associated with tenderness and no palpable bulge. A CT scan identified a right lower quadrant Spigelian hernia containing the right ovary and fallopian tube. A laparoscopic transabdominal preperitoneal repair with mesh was performed. Intraoperative evaluation showed a congested ovary. The patient was discharged postoperative Day 1. Spigelian hernias can involve the small intestine, greater omentum, or colon, while cases involving the gynecologic organs are rare. CT is key to diagnosis. A minimally invasive surgical approach should be considered given its potential benefits of decreased wound complications and its diagnostic and therapeutic utility.