Management of multiple sequential complications following coronary artery bypass grafting: a case report from Tanzania.

BACKGROUND: Coronary artery bypass grafting (CABG) is the gold standard treatment for advanced coronary artery disease (CAD). Postoperative complications can be life-threatening, particularly in patients with comorbidities. A 63-year-old male with triple-vessel CAD, diabetes mellitus, hypertension, obesity, and asthma underwent on-pump CABG using bilateral internal mammary artery grafts. The early postoperative course was complicated by traumatic sternal wound dehiscence following a fall on postoperative day 6, resulting in anterior chest wall dehiscence, rib fractures, and displaced sternal wires. Emergency re-exploration and modified Robicsek sternal closure were performed. The patient subsequently developed critical illness polyneuropathy and myopathy overlap syndrome (CIPNM), which gradually improved with supportive management and rehabilitation. He later developed deep sternal wound infection caused by Pseudomonas aeruginosa requiring prolonged targeted antibiotic therapy, repeated debridement, negative pressure wound therapy, removal of sternal wires, and pectoralis major flap reconstruction. Additional complications included arrhythmia, difficult airway management, acute kidney injury, pleural effusion, and electrolyte disturbances, all of which were managed successfully.

OUTCOME: Following eight months of coordinated multidisciplinary care and rehabilitation, the patient achieved complete wound healing and restored functional capacity.

DISCUSSION/CONCLUSION: This case illustrates the complexity of sequential post-CABG complications and emphasizes the importance of early recognition, multidisciplinary intervention, and structured rehabilitation in achieving favorable outcomes.