Medicolegal Aspects of Life-Threatening Late Hemorrhage after Tonsillectomy: Report of Three Cases and Review of Articles

Aims: Secondary bleeding after tonsillectomy is an unavoidable. If it leads to a life-threatening event, it is likely to 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 event in three patients and also to review the related literature. Methods: Here we report three cases of life-threatening secondary Post-tonsillectomy hemorrhage which were referred to the Legal Medicine Organization by prosecuting attorney to give an expert opinion about any medical negligence. Moreover, 11 articles on the complications of tonsillectomy and in some cases, complaints related to violations were selected for review in this study. Findings: Two cases resulted in death and underwent medicolegal autopsy. The third one caused a cardiopulmonary arrest which was followed by some 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. For avoiding illegal malpractice, obtaining informed consent, careful post-operation visits, and referring dead body for medicolegal autopsy in case of any fatality have been suggested as preventive measures to avoid getting involved in legal cases.