Background <p>Indirect inguinal hernia is rare in adult females and is usually attributable to congenital anatomical anomalies. It poses a high risk of incarceration and strangulation, risking ovarian ischemia, necrosis, or compromised fertility. Early diagnosis and timely intervention are therefore essential.</p> Case presentation <p>A 39-year-old woman presented with a left inguinal mass of 20 years’ duration, recently enlarging with intermittent discomfort. Physical examination revealed a firm, non-reducible left inguinal mass with a positive cough impulse. Radiological examination (ultrasonography and computed tomography) demonstrated probable left ovarian herniation, with the left adnexa absent from its anatomical location. Surgical exploration revealed that the hernia sac contained the left ovary, a dysplastic fallopian tube, and a portion of a rudimentary uterine horn. The patient underwent a one-stage laparoscopic transabdominal preperitoneal (TAPP) mesh hernia repair, resection of the rudimentary uterine horn, excision of the dysplastic fallopian tube, and oophoropexy, with an uneventful postoperative recovery.</p> Conclusions <p>&#xa0;This rare case highlights the diagnostic limitations of routine examinations in detecting female inguinal hernias associated with occult reproductive tract anomalies. Laparoscopic TAPP repair enabled simultaneous hernia correction and management of complex genital malformations, such as a rudimentary uterine horn and hypoplastic fallopian tube, while preserving ovarian function. This strategy prevented emergency complications and reoperation, providing a minimally invasive treatment that restores anatomy while preserving fertility and endocrine function in complex accessory hernias.</p>