Bilateral tension pneumothorax post-tonsillectomy: a case report of a rare and life-threatening complication of a common surgery.

INTRODUCTION AND

IMPORTANCE

Tonsillectomy is the most common procedure in otorhinolaryngology. The common indications are obstructive symptoms and recurrent tonsillitis. Often considered a low-risk procedure, postoperative complications can range from minor to major, such as emphysema, pneumothorax, and pneumomediastinum.

CASE PRESENTATION: A 3-year-old male was referred from a lower facility with a history of 4 hours post-adenotonsillectomy. The patient developed a sudden onset of extensive swelling of the face, neck, and chest, which was associated with difficulty breathing. The diagnoses were post-adenotonsillectomy and bilateral tension pneumothorax. An urgent chest X-ray before intervention revealed bilateral tension pneumothorax with bilateral lung collapse. Chest decompression was performed with a 16-gauge cannula, followed by bilateral chest tube insertion and decompression of subcutaneous emphysema. On the 10th day, the patient recovered and was successfully discharged.

CLINICAL DISCUSSION: Tonsillectomy is generally considered a safe procedure, but rare and potentially life-threatening complications, such as subcutaneous emphysema and tension pneumothorax, can occur. This case highlights the importance of early recognition and timely intervention in managing such rare postoperative complications.

CONCLUSION

Bilateral tension pneumothorax is a rare but life-threatening complication of tonsillectomy. Early recognition, prompt imaging, and immediate intervention are crucial for patient survival.