Unveiling a rare yet critical peril: Subcutaneous emphysema and pneumomediastinum post-tonsillectomy - A case report

This case report describes a highly unusual presentation of extensive subcutaneous emphysema (SE), pneumomediastinum (PM), and right-sided pneumothorax in a 6-year-old boy following an otherwise uneventful elective tonsillectomy. The patient’s intraoperative course, including the wound closure phase, remained completely stable, with no notable changes in hemodynamics or respiratory status observed. However, in the post-anesthesia care unit (PACU), the patient was suddenly diagnosed with crepitus, which rapidly spread from the face toward the chest. Concurrently, capnography showed persistent hypercapnia, with end-tidal CO₂ values ranging from 60 to 70 mmHg. Chest imaging confirmed the presence of SE, PM, and pneumothorax in the absence of tracheal or esophageal injury. The patient was managed conservatively with supplemental oxygen and close monitoring in an intensive care unit. No surgical intervention was required, and full recovery was observed within one week. This report also provides a brief literature review exploring the possible mechanisms behind these rare complications, as well as current evidence-based management strategies.