Postoperative spontaneous coronary artery dissection after major abdominal oncological surgery: a case report

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon non-atherosclerotic cause of acute coronary syndrome that can present as ST-elevation myocardial infarction (MI) and is particularly challenging because postoperative thrombosis and bleeding risks coexist. We report the case of a 44-year-old woman who underwent major abdominal oncologic surgery and developed a minor pulmonary embolism treated with anticoagulation. On postoperative day 4, she developed acute chest pain with ST-segment elevation. Emergency coronary angiography showed a long lesion involving the second diagonal branch, consistent with SCAD, with otherwise normal coronary arteries. She was managed conservatively. Her course was complicated by right JP drain-site bleeding, which required permanent heparin discontinuation and blood transfusion. This case illustrates SCAD as a cause of postoperative ST-elevation MI and the difficulty of balancing thrombosis and bleeding risk after major surgery.

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BibTeX RIS

BibTeX

@article{alsubaie2026postoperative,
  title = {{Postoperative spontaneous coronary artery dissection after major abdominal oncological surgery: a case report}},
  author = {Lamia S Alsubaie and Hesham Saida and Nayef Alzahrani},
  journal = {Journal of Surgical Case Reports},
  year = {2026},
  month = nov,
  doi = {10.1093/jscr/rjag968},
  url = {https://doi.org/10.1093/jscr/rjag968},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Postoperative spontaneous coronary artery dissection after major abdominal oncological surgery: a case report
AU  - Lamia S Alsubaie
AU  - Hesham Saida
AU  - Nayef Alzahrani
PY  - 2026
DA  - 2026/11/04
JO  - Journal of Surgical Case Reports
DO  - 10.1093/jscr/rjag968
UR  - https://doi.org/10.1093/jscr/rjag968
AB  - Spontaneous coronary artery dissection (SCAD) is an uncommon non-atherosclerotic cause of acute coronary syndrome that can present as ST-elevation myocardial infarction (MI) and is particularly challenging because postoperative thrombosis and bleeding risks coexist. We report the case of a 44-year-old woman who underwent major abdominal oncologic surgery and developed a minor pulmonary embolism treated with anticoagulation. On postoperative day 4, she developed acute chest pain with ST-segment elevation. Emergency coronary angiography showed a long lesion involving the second diagonal branch, consistent with SCAD, with otherwise normal coronary arteries. She was managed conservatively. Her course was complicated by right JP drain-site bleeding, which required permanent heparin discontinuation and blood transfusion. This case illustrates SCAD as a cause of postoperative ST-elevation MI and the difficulty of balancing thrombosis and bleeding risk after major surgery.
SN  - 2042-8812
ER  -

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