This is a case report of iliohypogastric nerve entrapment following abdominoplasty with plication of the anterior rectus sheath. Persistent lower abdominal pain postoperatively following abdominal surgery despite a negative gastrointestinal and/or gynecologic workup should alert the surgeon to the possibility of iliohypogastric or ilioinguinal nerve entrapment. Diagnosis is confirmed when there are pain and sensory impairment in the distribution of the nerve with relief of pain following nerve block. Treatment consists of neurectomy with proximal resection into the retroperitoneum to avoid painful recurrent neuroma within the ventral abdominal wall. Prevention of injury is best accomplished with thorough understanding of the course of the nerve in the lower abdomen.