Medicolegal Aspects of Life-Threatening Late Hemorrhage after Tonsillectomy; a Report of Three Cases

Aims: Secondary bleeding after tonsillectomy is unavoidable. If it leads to a life-threatening event, it will likely be associated with a malpractice claim against the surgeon. Very few reports have addressed this event from a medicolegal point of view. Therefore, the present report aimed to investigate litigations following secondary post-tonsillectomy hemorrhage leading to death or life-threatening events in three patients. Patients Methods: Here, we report three cases of life-threatening secondary post-tonsillectomy hemorrhage referred to the Legal Medicine Organization by the prosecuting attorney to give an expert opinion about any medical negligence. Findings: Two cases resulted in death and underwent medicolegal autopsy. The third one caused a cardiopulmonary arrest followed by neurological deficits after successful resuscitation. All three were children between 8 and 9 years old, and the time from surgery to post-tonsillectomy hemorrhage was between 30 hours to 13 days. No vascular anomaly or iatrogenic vascular injuries were found at autopsy. A review of the literature revealed that post-tonsillectomy hemorrhage is common and unpreventable Conclusion: In none of the cases medical malpractice was found as a contributing factor, and the complication was regarded as unpreventable.