Paradoxical bradycardia as a sign of silent bleeding resulting in a pelvic haematoma after an elective hernia repair.

We present the case of a 47-year-old man undergoing an elective laparoscopic inguinal hernia repair complicated by intra-operative asystole following pneumoperitoneum and a subsequent delayed intra-abdominal haemorrhage. Notably, he exhibited profound paradoxical bradycardia and hypotension in the context of significant haemorrhage, diverging from the expected tachycardic response. Management required prompt resuscitation, urgent re-exploration and intensive care support. Paradoxical bradycardia presents a diagnostic challenge, as limited awareness among clinicians may confer false reassurance of haemorrhagic resolution, thereby contributing to delayed intervention. This case report seeks to underscore this uncommon deviation from the classical physiological response, with the intention of mitigating diagnostic oversight in the management of peri-operative haemorrhagic shock and offers alternative clinical considerations to support early recognition.