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

Achoimre

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.