The left thoracoabdominal incision with retroperitoneal dissection offers excellent exposure of the abdominal and thoracic aorta. Disadvantages to this approach include inadequate access to the right ileofemoral arterial segments and the right renal artery. Additional difficulties with this approach include flank bulges, hernias, and neuropathy. We present a case of an incisional hernia at the tenth interspace with subsequent herniation of the left colon through this defect. CT defined the extent of this defect and ruled out other significant pathology. The patient underwent an uneventful herniorrhaphy. Abdominal-intercostal hernias have not been previously reported in association with the retroperitoneal aortic repair.