Abstract Para-vesical internal hernias are rare but serious complications of abdominal surgeries and can present as small bowel obstruction (SBO). We report the case of a 30-year-old woman with a history of Cesarean delivery 9 years prior, who presented with crampy abdominal pain, bilious vomiting, and obstipation. Imaging revealed findings consistent with SBO. Exploratory laparotomy confirmed a para-vesical internal hernia with patchy ischemia of the bowel. The hernia was reduced, and the defect was repaired. The patient recovered uneventfully and was discharged on postoperative day five. This case highlights the importance of considering internal hernias in the differential diagnosis of SBO in patients with prior abdominal surgery. Early surgical intervention is critical to prevent bowel ischemia and further complications.