Intra-Abdominal Compartment Syndrome Secondary to Massive Pelvic Müllerian Tumor

Abdominal compartment syndrome (ACS) is a rare surgical emergency characterized by end-organ dysfunction resulting from sustained elevation of intra-abdominal pressure. Gynecological malignancies are an uncommon cause of ACS. We report the case of a 61-year-old woman who presented following an unwitnessed fall with hypotension, tachycardia, confusion, and marked abdominal distension. Initial laboratory investigations demonstrated severe acute kidney injury (AKI), hyperkalemia, anemia, and markedly elevated inflammatory markers. Computed tomography (CT) imaging revealed a massive septate cystic pelvic mass causing compression of the inferior vena cava (IVC) and displacement of bowel loops, with associated liver lesions and lymphadenopathy concerning for metastatic gynecological malignancy. Ongoing hemodynamic instability and evidence of end-organ dysfunction raised suspicion for ACS. The patient underwent emergency decompressive laparotomy with drainage of approximately 6 liters of cystic fluid, followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy. Her postoperative course was complicated by persistent AKI, anemia, bilateral femoral vein thromboses, Clostridioides difficile infection, and lower-limb ulcers secondary to chemical burns. Initial histopathological findings were inconclusive; however, subsequent lymph node biopsy confirmed metastatic high-grade adenocarcinoma consistent with an ovarian or Müllerian primary malignancy. Due to advanced metastatic disease and profound frailty, the patient was deemed unsuitable for systemic oncological treatment and was transitioned to palliative care. She later died while receiving end-of-life support.