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Of note the patient made a very good recovery from the original bowel surgery and had returned to normal bowel function 3?days postoperatively. He eventually made a good functional recovery from his fasciotomies and is making good progress with intensive physiotherapy. Discussion Compartment syndrome is a condition which, if undetected, will  cause considerable morbidity and mortality. Commonly seen by emergency room and [http://en.wikipedia.org/wiki/Tryptophan_synthase Tryptophan synthase] orthopaedic trauma teams in association with long bone fractures, it is not regularly seen on a general surgery ward. Knowledge that compartment syndrome may occur following procedures with the patient in a lithotomy position for a prolonged time period and an understanding of the presenting symptoms and signs should aid the surgical team in early detection and treatment of this condition. Delayed diagnosis of compartment syndrome has occasionally been linked with the usage of epidural analgesia, but a review of these cases shows that analgesic demands and pain are  still high.3 The delay is not due to the PCA but more to the fact that the diagnosis is not considered. Risk factors associated with the development of compartment syndrome following colorectal surgery include the lithotomy position and surgery lasting more than 4?h.4 This case is unique in that only the tibialis anterior muscle was affected. No mechanism was clearly demonstrated to have caused this; however, the fact that this was a unicompartmental process is notable. We hope that highlighting this case and discussing the potential pitfalls of epidural PCA will increase awareness of this condition. In summary, any patient with increasing and abnormal/unexpected pain following laparoscopic surgery and higher usage of analgesia than expected should trigger a review by doctors to rule out compartment syndrome. Learning points Compartment syndrome is a potential complication of laparoscopic abdominal surgery. Use of postoperative analgesia such as epidurals can mask the initial pain associated with compartment syndrome. Any patient with unexpected pain and  increasing use of postoperative analgesia following laparoscopic surgery should trigger a review to rule out compartment syndrome. Footnotes Contributors: All the authors were involved in the management of the patient and the writing and reviewing of the manuscript. Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""A 35-year-old man previously asymptomatic, non-smoker presented with a history of acute onset severe ischaemic pain, paraesthesia and pulselessness involving the left upper limb from the axillary artery distally since 3?days, not preceded by fever or chest pain. ECG was normal and transthoracic echocardiogram showed a normally functioning heart with an abnormal mass in the arch of aorta, which could not be characterised adequately. There was no aortic regurgitation.