Patients with trisomy 21 present perioperative challenges due to anatomical and physiological factors that increase their risk of respiratory complications. Tonsillectomy, a common surgical intervention in this population, carries significant postoperative morbidity and mortality risks. We report the autopsy findings of a two-year-old child with trisomy 21 and a history of recurrent tonsillitis, who underwent tonsillectomy and adenoidectomy under general anesthesia. Despite an uneventful surgical procedure, the patient was discharged the same day while exhibiting inspiratory stridor. The child later developed worsening respiratory distress at home, leading to fatal outcome. The cause of death was determined to be respiratory distress secondary to supraglottic edema. This case underscores the critical importance of postoperative monitoring in patients with trisomy 21 undergoing tonsillectomy. Early discharge decisions should be made with caution, particularly in patients exhibiting respiratory distress. Strengthened postoperative observation protocols may help mitigate the risk of severe complications in this vulnerable population.

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