A young girl died days after undergoing a routine tonsil-removal (tonsillectomy) procedure, following what authorities have described as a very rare surgical complication, in the context of her diagnosis of cyclic vomiting syndrome (CVS). Reports indicate the child began vomiting the morning after surgery, a known trigger pattern for CVS, but was initially advised to monitor the situation. Later deteriorating symptoms, including infection and bleeding, led to her death four days post-surgery.
The case has reappeared in national headlines because a coroner’s inquest concluded in November 2025, delivering new findings that criticised the hospital’s postoperative decisions and highlighted missed opportunities to readmit the child when vomiting began.
An inquest concluded that the hospital should have readmitted her immediately when vomiting started, noting that medical staff may have lacked sufficient awareness of CVS and its potential perioperative risks. The coroner also found that the surgeon had little, if anything, knowledge of CVS and criticised the decision to discharge her on the same day of the operation.
Cyclic Vomiting Syndrome is a functional gastrointestinal disorder characterized by recurrent, sudden episodes of severe nausea and vomiting, often lasting hours to days, interspersed with symptom-free intervals that can last weeks to months.
Episodes typically follow a pattern, similar symptoms recurring at roughly the same times.
Symptoms may include intense nausea, repeated vomiting, abdominal pain, dehydration, and lethargy.
Although CVS can affect people of all ages, onset often occurs in early childhood.
The causes of CVS remain unclear. Hypotheses include abnormalities in the brain-gut axis, autonomic nervous system dysregulation, and genetic predispositions.
Medical literature suggests that physical stress, anesthesia, fasting, or surgery itself can act as a trigger for a CVS episode.
In a post-surgical setting, vomiting, common in CVS can lead to serious complications:
Dehydration: repeated vomiting may rapidly deplete fluids.
Esophageal injury or bleeding: forceful retching and vomiting can damage the esophagus.
Delayed wound healing or postoperative complications: vomiting after a throat or ENT surgery (like tonsillectomy) may stress surgical sites, increasing risk of hemorrhage or infection.
Given these risks, many experts say that children with known CVS, especially undergoing ENT or airway surgeries may warrant special perioperative care, longer hospital observation, and pre-emptive hydration & anti-nausea management.
The child, identified in the inquest as a five year old from Cornwall, underwent tonsil and adenoid removal on 5 April 2023 at the Royal Cornwall Hospital to treat sleep apnoea. She was discharged home a few hours after the 38 minute procedure, despite her parents expressing concern because of her CVS diagnosis.
She began vomiting in the early hours of the next morning. Her parents promptly called the hospital; they were told to wait and observe rather than return immediately. The vomiting persisted, reportedly around twenty times, and the child was brought back to the hospital later that evening.²
In hospital, she was treated with intravenous anti-emetics but later developed a chest infection. When her IV line failed, staff switched her to oral medications that she could not retain due to ongoing vomiting, leading to a period of almost fourteen hours without fluids, antibiotics, pain relief, or anti-sickness treatment.
At around 3:00 a.m. on 9 April, she suffered a massive haemorrhage, believed to be due to infection at the tonsillectomy site and rupture of a blood vessel. Attempts at resuscitation were unsuccessful, and she died at 4:37 a.m.
A paediatric pathologist confirmed the cause of death as massive haemorrhage with aspiration of blood, surgical site infection, and enlarged tonsils.
According to The Guardian, senior coroner, Andrew Cox, stated that the potential for a CVS episode to be triggered by surgery was readily foreseeable and that once vomiting began, she should have been readmitted immediately.
He also observed that the surgeon had limited knowledge of CVS and did not seek paediatric input before discharging the child, which may have contributed to inadequate postoperative planning.¹ Although he did not conclude that earlier readmission would have definitively prevented the death, he said more cautious management could have made a difference.
Because there is no definitive cure for CVS, management focuses on preventing episodes and treating them early:
Identifying and avoiding known triggers: certain foods, stress, fasting, sleep deprivation.
Medications: anti-nausea drugs, migraine-related treatments may help especially for frequent or severe episodes.
Supportive care during episodes: hydration, rest, and monitoring for complications like dehydration or electrolyte imbalance.
In surgical settings, especially, patients with CVS may benefit from pre-operative risk assessment, prolonged inpatient observation post-surgery, and clear discharge planning with caregivers.
References
IDDK (National Institute of Diabetes and Digestive and Kidney Diseases). “Cyclic Vomiting Syndrome.” Accessed November 29, 2025. https://www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome.
“Neurological Etiologies and Pathophysiology of Cyclic Vomiting Syndrome.” Pediatric Neurology (ScienceDirect). https://www.sciencedirect.com/science/article/pii/S2255534X24000616 sciencedirect.com
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