Although spigelian hernias are rare, they do not appear to be as uncommon as previously thought. Thirty-one cases, one a bilateral hernia, have been documented over the last ten years at a 350 bed community hospital. Spigelian hernias continue to be misdiagnosed preoperatively, often forgotten in the differential diagnosis, as physical examination is usually of little benefit. In this review younger individuals were more commonly affected than previously expected. Treatment continues to be surgical repair.