For over a century, raised intra-abdominal compartment syndrome (ACS) has been known. The physiology and clinical results of this syndrome produce significant morbidity and quite high mortality rates. Increased intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines as well as other peritoneal and retroperitoneal structures, including the pulmonary, cardiovascular, renal, splanchnic, and central nervous systems. The most effective prevention of ACS is early recognition and preemptive interventions, as well the choice of appropriate abdominal closures with constant care and surveillance in intensive care units.