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The Authors report a case of abdominal compartment syndrome due to a giant ovarian serous cystadenoma. Despite of the relief of intra-abdominal hypertension (IAP: 16 mmHg), mild symptomatology (clinostatic dyspnea) lead to defer the emergency surgical treatment; after CT scan of abdomen and pelvis was performed a resection en bloc of the cystic mass, oophorectomy and cholecystectomy. However it seems advisable to perform an emergency laparotomy in patients with abdominal compartment syndrome (ACS) grade II when presenting as an acute abdomen.