Abdominal compartment syndrome is a rare emergency condition characterized by the development of organ dysfunction due to increased intra-abdominal pressure. Gynecologic conditions are an uncommon etiology of abdominal compartment syndrome. We report a case of a 35-year-old woman who presented with severe abdominal pain and vomiting. The patient had a history of long-standing gastroesophageal reflux disease. On physical examination, the abdomen was distended and tense, suggestive of acute abdomen. Computed tomography revealed a large abdominopelvic cystic lesion, arising from the ovary, causing a significant pressure effect on the abdominal viscera. The patient's condition deteriorated and had an altered level of consciousness with hemodynamic instability. She was intubated and received inotropic support. Subsequently, a life-saving emergency surgical decompression was performed. The ovarian cyst was evacuated and yielded 10 liters of fluid. Histopathological examination confirmed the diagnosis of ovarian cystadenoma. The patient remained in the intensive care unit postoperatively and was discharged in a good condition after 14 days of hospitalization. The case emphasizes the importance of considering abdominal compartment syndrome in patients with a clinical picture of acute abdomen. Failure to recognize this condition can lead to multiorgan failure and death.