Benign Surgery, Malignant Rhythm: Post-laparoscopic Sick Sinus Syndrome in a Child

Laparoscopic appendectomy is one of the most frequently performed surgical procedures in pediatric surgery and is considered highly safe. Hemodynamic changes produced by pneumoperitoneum are usually transient and clinically insignificant in otherwise healthy children. We report the case of a nine-year-old boy who developed severe postoperative bradycardia and hypotension following an uncomplicated laparoscopic appendectomy. Electrocardiography and echocardiography demonstrated findings suggestive of sick sinus syndrome with transient ventricular dysfunction requiring inotropic support. The child recovered completely within 72 hours with conservative management. This case highlights an uncommon but important cardiovascular complication following pneumoperitoneum and emphasizes the need for vigilant postoperative monitoring even after routine laparoscopic surgery in children.