Background <p>Primary suprapubic hernias are rare abdominal wall defects, particularly in women without prior pelvic or lower abdominal surgery. Their deep anatomical location and soft-tissue contents may cause clinical and radiological misdiagnosis as inguinal hernias.</p> Case presentation <p>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.</p> Conclusion <p>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.</p>