Background: Acute compartment syndrome (ACS) is a life-threatening process induced by abnormally high pressure between muscles and enveloping fasciae. There are few reports in connection with gynecologic surgery. Case: A 38-year-old patient underwent extended surgery for a malignant yolk sac tumor of the ovary. The operating time was almost 6 hours, and anesthesia time and time in lithotomy position was almost 7 hours. On the first postoperative day, the patient reported pain and swelling in the lower left leg and ACS was diagnosed. An immediate fasciotomy with necrectomy of the soleus muscle was performed. The patient subsequently required repeated debridement on the 4th and 6th postoperative days. Five (5) months postoperatively, after physical therapy, the patient was well and mobile but her foot drop persisted. Conclusions: ACS is a clinical diagnosis confirmed by laboratory findings. It is well-known to trauma and plastic surgeons, but the well-leg variant is rare and may not be familiar to gynecologic surgeons. Gynecologic surgeons need to be aware of this potential problem in patients at risk. (J GYNECOL SURG 26:261)
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