We present a case report of a young man found to have Crohn's appendicitis in an incarcerated spigelian hernia, initially diagnosed via laparoscopy. We have found two published cases of incarcerated appendicitis in spigelian hernias; however, only one of them also showed histologic evidence of Crohn's disease, and neither was discovered during laparoscopy. Therefore, we submit this rare case presentation and discuss the advantages of laparoscopy as an aid in diagnosing the cause of chronic abdominal pain.