From the Guidelines

Yes, a giant uterine leiomyoma (fibroid) can cause abdominal compartment syndrome.

The abdominal cavity is a semirigid container with a finite volume, and when the intra-abdominal volume increases due to any reason, including a large uterine leiomyoma, the intra-abdominal pressure (IAP) rises 1.
Intra-abdominal hypertension (IAH) is a ubiquitous feature of critical illness/injury and can lead to visceral ischemia and adverse outcomes, even if mild 1.
Abdominal compartment syndrome (ACS) is defined as an intra-abdominal pressure higher than 25 mmHg in association with any organ dysfunction and requires emergent treatment 1.
A large uterine leiomyoma can increase the intra-abdominal volume, potentially leading to IAH and ACS, especially if the tumor is large enough to cause significant abdominal distension.
Risk factors for ACS, such as abdominal distension, can be applicable to a giant uterine leiomyoma, increasing the risk of developing ACS 1.
Given the potential for a giant uterine leiomyoma to cause significant abdominal distension and increase intra-abdominal pressure, it is reasonable to consider ACS as a possible complication in patients with large uterine leiomyomas.

From the Research

Abdominal compartment syndrome (ACS) is a rare condition characterized by sustained elevated intra-abdominal pressure leading to organ failure 2.
A case study presented a 25-year-old patient with massive uterine fibroids who required indicated preterm delivery via primary cesarean section at 25 weeks gestation, and her postpartum course was complicated by ACS, requiring emergent surgical decompression 2.
The study suggests that when a large fibroid burden is present during pregnancy or in the postpartum period, ACS should be considered in the differential diagnosis 2.

Giant uterine leiomyomata are a unique and tiny subset of the millions of women with fibroids, and their optimal surgical management requires careful attention to considerations and techniques not common to the typical myomectomy or hysterectomy 3.
A case report presented a 49-year-old woman who underwent a total abdominal hysterectomy of a 13.5-kg uterine leiomyoma with no malignancies at histopathology, and the literature review suggested that large volumes do not always pose a threat regarding malignancy 4.
Another case report presented a 47-year-old woman with a massive lesion, with both solid and cystic components, occupying the entire abdominopelvic cavity, which was confirmed to be a cellular leiomyoma 5.

Large uterine myoma may cause secondary polycythaemia by three postulated mechanisms, including presence of hypoxia, compression of the ureters resulting in excessive production of erythropoietin, and production of erythropoietin by the tumour itself 6.
The presence of a giant uterine leiomyoma can mimic an ovarian neoplasm, leading to significant diagnostic and management challenges 5.
Early diagnosis and timely surgical decompression are necessary to prevent organ dysfunction and worsening maternal outcomes in cases of ACS caused by giant uterine leiomyoma 2.