The abdominal compartment syndrome refers to the constellation of altered regional blood flow, abnormal respiratory mechanics, cardiovascular dysfunction, and oliguria that occurs as a result of a sustained increase in intra-abdominal pressure. Although the syndrome may follow a diverse series of insults, the most common predisposing clinical entities are severe abdominal trauma and ruptured abdominal aortic aneurysm. Diagnosis depends on recognition of the clinical syndrome followed by some objective measure of intra-abdominal pressure. When the condition is severe, management requires abdominal decompression. Despite urgent decompression, mortality is high owing to the severity of the patients' underlying illnesses.