Abdominal Compartment Syndrome Due to Large Ovarian Cystadenoma: A Case Report

Abstract

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.

Uterine Leiomyomata as a Cause of Abdominal Compartment Syndrome in the Postpartum Period

“…ACS is a clinical diagnosis that may or may not be supported by an intra-abdominal pressure threshold of >20mm Hg. 14 Given the abdominal exam findings, along with oliguria, increasing hypoxia, worsening kidney function, vulvar and lower extremity edema, and overall evidence of hypoperfusion, the patient met criteria for ACS. 11 Initial management of ACS includes supportive measures and careful observation.…”

“…Case reports have demonstrated ACS as a complication from massive ovarian cystadenomas, uterine artery embolization, or heterotopic ectopic pregnancies. 11,[25][26][27] ACS is an excessive increase in IAP greater than 12 mm Hg that contributes to early organ dysfunction. The World Congress on Abdominal Compartment Syndrome grades ACS based on the IAPs-Grade 1: 12 to 15 mm Hg, Grade 2: 16 to 20 mm Hg, Grade 3: 21 to 25 mm Hg, Grade 4: more than 25 mm Hg.…”