Compartment syndrome is a condition in which fascial compartment pressure exceeds perfusion pressure, causing tissue ischaemia and necrosis. Well leg compartment syndrome (WLCS) is defined as an acute lower limb compartment syndrome that develops in the absence of trauma and may occur without pre-existing vascular disease. It is associated with prolonged stay in an elevated leg position during pelvic surgery. The incidence of WLCS has been reported at 1 per 3,500 lithotomy patients. Prevention of WLCS is one of the most critical challenges, for which local protocols and standards are needed. Early detection of perioperative WLCS symptoms and signs and early surgical treatment are crucial to prevent its life-threatening outcomes. We present a case of a 47- year-old female who developed WLCS following a >8 hour operation in the lithotomy position. Urgent fasciotomy was performed 4 hours after the onset of symptoms. The institutional protocol needs to be implemented to avoid further damage.