Preoperative diagnosis and laparoscopic management of Amyand's hernia with isolated factor VII deficiency: A case report.

Abstract

Introduction and importance: Amyand's hernia is a rare condition in which the vermiform appendix herniates through the inguinal canal, with an estimated prevalence of 1 %. Isolated factor VII deficiency is part of a rare group of coagulopathies, with an incidence of 1 in 50,000. To our knowledge, this is the first documented report of Amyand's hernia with isolated factor VII deficiency.

Case presentation: We present a 59-year-old male with a 4-month history of progressive right scrotal swelling. Computed tomography revealed herniation of the appendix into the inguinal canal, confirming Amyand's hernia. Routine preoperative laboratory evaluation showed factor VII deficiency. Transabdominal preperitoneal hernia (TAPP) repair was done successfully without appendectomy, as the appendix was not inflamed.

Clinical discussion: Amyand's hernia is often diagnosed intraoperatively, though CT and ultrasonography enable preoperative recognition. Management is typically guided by the Losanoff and Basson classification. The role of prophylactic appendectomy in uninflamed appendices remains debated; in this case it was avoided to preserve a clean surgical field. The factor VII deficiency required perioperative recombinant factor VII replacement, which was successful.

Conclusion: Amyand's hernia with isolated factor VII deficiency is rare and has no standard treatment protocol, but we were able to perform surgery safely with appropriate precautions.