Primary suprapubic hernia containing epiploic appendages mimicking an inguinal hernia in a postmenopausal woman

Background Primary suprapubic hernias are exceptionally rare, particularly in women without prior pelvic or lower abdominal surgery. Owing to their close anatomical relationship to the inguinal region, these hernias may clinically and radiologically mimic inguinal hernias. Small suprapubic defects, especially those containing soft tissue such as fat or epiploic appendages, may remain occult on preoperative imaging. Case presentation: A 60-year-old woman presented with a left inguinal swelling that was clinically consistent with a direct inguinal hernia. Computed tomography (CT) imaging confirmed the inguinal hernia but did not reveal any suprapubic defect. During laparoscopic transabdominal preperitoneal (TAPP) repair, an unexpected primary suprapubic hernia containing epiploic appendages of the sigmoid colon was identified. Defect was reduced and repaired using a 3D Prolene mesh covering the entire myopectineal orifice. Postoperative recovery was uneventful, and follow-up demonstrated excellent functional and cosmetic outcomes without recurrence. Conclusion This case underscores that primary suprapubic hernias in women can closely mimic inguinal hernias and may be missed on preoperative imaging. Laparoscopic TAPP repair allows accurate intraoperative identification of occult defects and facilitates comprehensive anatomical repair with favorable outcomes.