BACKGROUND Herpes zoster infection typically involves the posterior root ganglia and most of the symptoms are sensory. Motor involvement can occur in the same distribution but is relatively uncommon. Segmental zoster paresis is a rare motor complication of Herpes zoster, mimicking an abdominal hernia, but it needs no surgery different from the real abdominal wall hernia. METHODS We present a case of a 58-year-old man with an abdominal protrusion and characteristical herpes zoster rash. METHODS Initially, the surgeon regarded it as an abdominal hernia, while ultrasonography excluded the abdominal wall defect, and then the dermatologist diagnosed it as segmental herpes zoster abdominal paralysis. METHODS He received a treatment with oral acyclovir, mecobalamin, and vitamin B1. RESULTS The abdominal wall bulge disappeared after 2 months, avoiding unnecessary surgery. CONCLUSIONS Segmental zoster abdominal paresis, mimicking an abdominal hernia needs no surgery.