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Case Reports
. 2024 Feb 18;14(1):e74-e79.
doi: 10.1055/a-2164-8100. eCollection 2024 Jan.

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

Mason Hui  1 , Baha Sibai  1 , Alvaro Montealegre  1 , Mateo G Leon  1
Affiliations
Case Reports

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

Mason Hui et al. AJP Rep. .

Abstract

Uterine leiomyomas are common benign smooth muscle tumors that often occur during the reproductive years. Although many cases may not result in significant complications, negative pregnancy outcomes have been associated with the size and location of the fibroids. Degeneration of fibroids can occur as early as the late first trimester when they undergo significant volumetric growth, contributing to pain during pregnancy. While myomectomy is typically avoided during pregnancy, conservative management with anti-inflammatory medications may be effective. Surgical removal or preterm delivery may be necessary if symptoms persist. Abdominal compartment syndrome (ACS) is a rare condition characterized by sustained elevated intra-abdominal pressure leading to organ failure. Although ACS resulting from large-volume leiomyomas in the postpartum period has not been previously described, we present a case of a 25-year-old patient with massive uterine fibroids who required indicated preterm delivery via primary cesarean section at 25 weeks gestation. Her postpartum course was complicated by ACS, requiring emergent surgical decompression. When a large fibroid burden is present during pregnancy or in the postpartum period, ACS should be considered in the differential diagnosis. Early diagnosis and timely surgical decompression are necessary to prevent organ dysfunction and worsening maternal outcomes.

Keywords: abdominal compartment syndrome; postpartum; pregnancy; surgical decompression; uterine leiomyoma.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
( A ) Magnetic resonance imaging (coronal) showing 24 cm fibroid uterus demonstrating external compression on the fundus with live intrauterine pregnancy at 23 weeks gestation. ( B ) Sagittal view.
Fig. 2
Fig. 2
Abdominal compartment syndrome noted on postoperative day 4 after delivery from primary cesarean section.
Fig. 3
Fig. 3
Computed tomography (sagittal) imaging of massive multifibroid uterus with dilated loops of bowel and large volume ascites. ( A ) Largest subserosal fibroid measuring 24 × 17 cm. ( B ) Multiple smaller fibroids measuring 6.7 × 5.8 cm and 4.2 × 4 cm.
Fig. 4
Fig. 4
Intraoperative findings of massive multifibroid uterus totaling 9,290 g.
See this image and copyright information in PMC

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