Primary ventral hernia (PVH) is a main differential diagnosis of abdominal wall masses and typically occurs at areas of structural weakness, such as the linea alba. This report draws attention to atypical PVHs of the peri-inguinal region, an underdiagnosed subgroup of defects located adjacent to the inguinal canal and below the semilunar line. The absence of a standardized definition or classification complicates the diagnosis of this infrequent pathology. We present a case of a patient with a tender abdominal wall mass, initially interpreted as superinfected hematoma. Despite drainage, the patient's physical condition continued to deteriorate. Repeat imaging eventually revealed acute appendicitis inside a peri-inguinal hernia. Laparoscopic appendectomy was performed, and the abscess cavity was incised, debrided and left open, which led to successful secondary closure of the wound. This case highlights the need for greater awareness of atypical hernias and their potential complications to enable timely detection and adequate treatment.