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.