Emergency Laparoscopic Appendectomy in a High-Risk Cardiac Patient With Severe Left Main Coronary Artery Disease on Dual Antiplatelet Therapy

Abstract

Emergency noncardiac surgery in patients with advanced coronary artery disease and recent coronary stent implantation poses a substantial anesthetic challenge. Clinicians must carefully balance the heightened risk of perioperative bleeding associated with continued dual antiplatelet therapy against the potentially catastrophic risk of stent thrombosis if such therapy is interrupted. We described the perioperative management of a 68-year-old man with severe multivessel coronary artery disease, critical left main stenosis, impaired left ventricular function, and recent coronary stenting, who required emergency laparoscopic appendectomy for perforated appendicitis. General anesthesia was administered with comprehensive invasive hemodynamic monitoring and tailored vasopressor support. The procedure was completed successfully, and the postoperative course was uneventful. This case underscored the feasibility of proceeding with emergency laparoscopic abdominal surgery without interruption of dual antiplatelet therapy in a patient with high-risk coronary anatomy, including left main disease. It highlighted a pragmatic, individualized anesthetic strategy integrating advanced hemodynamic monitoring, goal-directed support, and close multidisciplinary coordination, offering practical insight into managing the competing risks of bleeding and stent thrombosis in time-critical surgical settings.