A 39-year-old lady with Down’s syndrome presented with right iliac fossa pain to the emergency department. Computed tomography abdomen pelvis revealed a foreign body in the right lower anterior abdominal wall. We report the first case of using laparoscopic totally extraperitoneal (TEP) approach to remove an ingested foreign body that likely perforated through the gastrointestinal tract and subsequently migrated to the anterior abdominal wall. Granted, the laparoscopic TEP approach is more widely used in inguinal hernia mesh repairs and increasingly prostatectomies; we believe that the TEP approach could also be used in a novel fashion as in this case.