OBJECTIVE : Type II post-obsrtuctive pulmonary edema (POPE type II) is considered as a rare and life threatening complication of adenotonsillectomy that can contribute to higher chance of mortality. Through this case report, we hope to raise awareness about the complications of post-obstructive pulmonary edema that can occur in post-operative adenotonsillectomy. Early diagnosis and detection is needed in order to prevent further deterioration by initiating immediate management for the condition. 	
CASE : A 3-year-old male child underwent adenotonsillectomy with an initial diagnosis of OSA (obstructive sleep apnue) due to adenotonsillar hypertrophy. Eleven hours postoperative, the patient experienced sputum retention and shortness of breath. Vital signs showed tachycardia, tachipnoe and desaturation. Upon physical examination, chest retraction and rales were found. Chest X-Ray showed that there was patchy shadowing in right and left lung. As the patient was in respiratory distress he was re-intubated to maintain airway patency and PEEP (positive expiratory end pressure) was used to carry out oxygenation with SIMV ventilator mode. After 6 days of close monitoring in the ICU, with the total of 4 days on ventilator, the patient's condition improved.

CONCLUSION: Post-obstructive pulmonary edema is a rare and life-threatening complication of adenotonsillectomy. Prompt diagnosis and proper treatment is crucial to prevent fatal outcome in this case