The abdominal compartment syndrome (ACS) is a life threatening disorder in critically ill patients caused by rapidly decreasing intra-abdominal pressure (IAP) > 12 mm Hg, which may result in multiple organ dysfunctions with a possibly fatal outcome. Under various causes for the development of an ACS, pelvic trauma, volume resuscitation after severe hemorrhage and reperfusion after aortic aneurysm repair as well as intra-abdominal packing figure at the first place. An increased BMI is a risk factor for patients to suffer from ACS. In addition, excessive volume requirement and significantly increasing airway pressures within the first 24 hrs after admission in the ICU are indicators for an impending ACS. Increased IAP causes venous stasis and arterial malperfusion of all intra- and extra-abdominal organs thus resulting in ischemia, hypoxia and necrosis. In parallel, respiratory, cardiocirculatory, renal, intestinal and cerebral decompensation can be registered. Final multiorgan failure has a mortality around 60-70 %. Timely diagnosis of ACS remains sometimes difficult in spite of clinical indicators such as increased airway pressure, hypoxia, oliguria, shock and acidosis. For the early recognition of intra-abdominal hypertension repetitive measurement of the intra-vesical pressure (> 20 mm Hg) can be helpful. Besides intensive care treatment with artificial ventilation, circulatory support with volume and catecholamines, the decision for a prompt abdominal decompression and open abdominal treatment is life-saving and can preserve further functional damage to vital organ systems.
