Introduction: Acute compartment syndrome (ACS) is an orthopedic emergency which if not recognized and treated in time can lead to serious irreversible damage to neuromuscular structures. Case Report: We are reporting here a case of acute compartment syndrome of the right leg in an adult male patient following a prolonged urological surgery of five hours in the lithotomy position. Post-operatively the patient's signs and symptoms were diagnosed early and an urgent fasciotomy was done which relieved him of his symptoms and averted major damage to his leg. Conclusion: Acute compartment syndrome of the leg is a recognized but rare iatrogenic complication in many prolonged urological procedures due to lithotomy position used in them. If prolonged urological procedure is necessary patient should be monitored post operatively for early and prompt treatment of this complication. Early diagnosis and prompt treatment is the main-stay of the treatment in cases of acute compartment syndrome following unavoidable prolonged urological procedures in lithotomy position. We recommend a written consent and information to the patient regarding the risk of the above. In our case urgent decompression by four compartment fasciotomy was successful and averted all disabling complications.
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