Appendicitis is one of the most common surgical emergencies, and is usually diagnosed clinically on point tenderness in the right iliac fossa. The diagnosis can be difficult if there is abnormal anatomy. This case looks into the presentation of appendicitis within an incisional hernia secondary to radical nephrectomy. Appendicitis may present within hernias, and there should be a low threshold for computed tomography assessment of hernias when there is clinical doubt about the symptoms associated with the hernia.