Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. The majority of patients present with symptomatic incarceration of preperitoneal fat or intra-abdominal viscera. Radiographic studies are beneficial in confirming the diagnosis. The high rate of incarceration with or without strangulation mandates operative repair once the diagnosis is confirmed. This manuscript outlines the clinical presentation and management of a patient with an incarcerated Spigelian hernia.