Introduction Acute gluteal compartment syndrome (GCS) is a rare and diagnostically challenging surgical emergency, most associated with prolonged immobilisation from trauma or overdose. Presenting with disproportionate pain, rhabdomyolysis and neuropathies, rapid identification and surgical decompression is pivotal to mitigate significant morbidity and mortality. We report a unique case of sequential post-operative bilateral GCS in an obese patient. Case Presentation A 61-year-old with a BMI of 48 experienced right GCS following elective parotid mass excision then subsequent left sided GCS over a week later. His initial surgery was uncomplicated, performed supine, and lasted 3 hours. In recovery he reported excruciating right hip pain and new tea-coloured urine was noted, suspicious for rhabdomyolysis. His initial creatine kinase (CK) was significantly elevated (>100,000) with a normal XRAY and CT pelvis and tense gluteal compartment on examination. He underwent an emergency fasciectomy, with good tissue perfusion post release. His CK declined appropriately and return to theatre demonstrated ongoing perfusion of all compartment musculature. Despite appropriate post-operative management including mobilisation and proning, he experienced new exquisite left gluteal tenderness and sciatic nerve palsy one week post initial GCS fasciotomy and consequently required a left fasciectomy that day. Intra-operative biopsies were negative for myositis and subsequent returns to theatre required minimal debridement. His sciatic nerve palsy steadily improved. Discussion GCS is a very rare surgical complication and case reports in post-operative otolaryngology patients have not been described. This atypical case highlights the importance of clinician vigilance, particularly in prolonged procedures and as morbidly obese surgical patient numbers rise. Rapid recognition of GCS symptoms/signs and prompt fasciectomy can prevent significant morbidities like renal failure, permanent neurological injury and death.