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

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Postoperative spontaneous coronary artery dissection (SCAD) presenting as ST-elevation myocardial infarction (n=1). Intervention: Conservative medical management and individualized antithrombotic therapy (aspirin, beta-blocker, and resumed enoxaparin after heparin/clopidogrel discontinuation). Primary outcome: Clinical resolution of chest pain and symptom-free survival at follow-up.

Q: What does this research mean for the field?

Conservative management combined with individualized antithrombotic therapy can successfully resolve postoperative spontaneous coronary artery dissection complicated by pulmonary embolism and active surgical bleeding. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lamia S Alsubaie; Hesham Saida; Nayef A Alzahrani

doi:10.1093/jscr/rjag968

November 1, 2026Journal of Surgical Case ReportsOpen Access

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

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Key result

Individualized conservative antithrombotic therapy resolves concurrent postoperative SCAD and pulmonary embolism.

n=1

Why the study?

Spontaneous coronary artery dissection is an uncommon non-atherosclerotic cause of acute coronary syndrome that can present as ST-elevation MI and is particularly challenging in the postoperative setting because thrombosis and bleeding risks coexist.

Key Points

To report a rare presentation of spontaneous coronary artery dissection following extensive abdominal oncologic surgery and illustrate the challenge of balancing thrombosis against postoperative bleeding.
Clinical case evaluation of a 44-year-old female who developed ST-elevation myocardial infarction on postoperative day 4 following major multivisceral abdominal oncologic resection (N=1).
Diagnostic workup included electrocardiography, cardiac biomarker assessment, computed tomography pulmonary angiography, and emergency radial coronary angiography.
Coronary angiography showed a long lesion extending from the ostium to the distal segment of the second diagonal branch consistent with spontaneous coronary artery dissection, accompanied by troponin-I elevation from under 10 ng/L to 13764.3 ng/L.
The clinical course was complicated by surgical drain-site hemorrhage with active extravasation, requiring heparin and clopidogrel cessation, transfusion of 3 units of packed red blood cells, and conservative management leading to discharge on day 17.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 44-year-old woman with hypertension and dyslipidemia who developed SCAD presenting as ST-elevation MI on postoperative day 4 after major abdominal oncologic surgery, complicated by minor pulmonary embolism and surgical drain-site bleeding.

I

Intervention

Conservative management without percutaneous coronary intervention; initial heparin infusion and dual antiplatelet therapy (aspirin and clopidogrel) revised after drain-site bleeding to permanent discontinuation of heparin and clopidogrel, transfusion of 3 units of packed red blood cells, continuation of aspirin once daily, optimization of beta-blocker therapy, and resumption of enoxaparin 40 mg twice daily for pulmonary embolism (continued for 30 days upon discharge).

O

Outcome

Clinical resolution of chest pain and symptom-free survival at hospital discharge (after a 17-day hospital stay) and follow-up.hard clinical

This case report highlights the diagnostic and therapeutic complexity of managing postoperative spontaneous coronary artery dissection presenting as STEMI when complicated simultaneously by acute pulmonary embolism and surgical site bleeding.

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Implication

May inform individualized antithrombotic decisions in postoperative SCAD with bleeding; leaves open optimal strategies pending larger studies.

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.

Discussion

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Cite This Study

Alsubaie et al. (2026) conducted a case report in Postoperative spontaneous coronary artery dissection (SCAD) presenting as ST-elevation myocardial infarction (n=1). Conservative medical management and individualized antithrombotic therapy (aspirin, beta-blocker, and resumed enoxaparin after heparin/clopidogrel discontinuation) was evaluated on Clinical resolution of chest pain and symptom-free survival at follow-up.

synapsesocial.com/papers/6aee6bc771a7594806220b26 https://doi.org/10.1093/jscr/rjag968

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

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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