Abdominal compartment syndrome has a clearly defined clinical appearance which, in my opinion, does not receive enough attention. Although described nearly 100 years ago, it has only gained acceptance in the last few years. The probable causes are various and are based on an abdominal volume increase that leads to disorders in multiple organs and systems: cardiac, circulatory, pulmonary, renal, hepatic, intestinal and central nervous, up to multiple organ failure. Only detection followed by surgical abdominal decompression as early as possible can prevent an otherwise lethal outcome. In risk situations, if in doubt, the abdomen should not be dosed primarily, R should rather be left open until closure can be safely performed.