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The American alligator (Alligator mississippiensis) is a large (total length to 4.5 m [14.7 ft]) crocodilian common (estimated 3–4 million) in the southeastern United States. Attacks by alligators on humans are infrequent but increasing. We provide a case report of a scuba diver attacked by an adult alligator, describe the outcome, and discuss the injuries sustained by the diver. This attack occurred in the Cooper River of coastal South Carolina. The diver was seized by the right arm moments after surfacing and, in turn, hugged the alligator to avoid further trauma in the event of a death roll. The alligator carried the diver to the riverbed (estimated depth 15 m). The victim gouged the eyes and jaws of the alligator with a screwdriver, effecting his release, and then surfaced slowly to avoid decompression sickness. Subsequent medical examination indicated that the diver suffered a Monteggia fracture of the right ulna, characterized by an anterior dislocation of the radiocapitellar joint, and an oblique fracture of the proximal ulna. The Monteggia fracture was repaired by open reduction and internal fixation, with plate and screw fixation of the proximal ulna, postoperative alignment of the radiocapitellar joint, and staple fixation of the traumatic forearm. We estimated the total length of the alligator to be between 3 and 4 m and attribute the diver's survival to a number of factors—most notably the diver was equipped with scuba gear that allowed continued breathing when he was pulled beneath the water's surface by the alligator.