Abdominal intercostal herniation occurs rarely, with only 27 previous cases reported in the literature. An 84-year-old man presented with a painful large thoraco-abdominal mass. He had no history of trauma or surgery to the chest or abdomen. A thoraco-abdominal computerized tomography scan revealed a protrusion of intra-abdominal omental fat into a sac between the left eighth and ninth ribs. We present a novel technique for the repair of this uncommon condition. There were no peri-operative complications and the patient was asymptomatic on review 9 months later. We suggest that a laparoscopic approach may be used for treatment of an uncomplicated abdominal intercostal hernia.