Compartment syndromes can occur in many body regions. Abdominal compartment syndrome, initially described many years ago, has become increasingly recognised in critical care patients. The key points regarding its definition, pathophysiology, aetiology and treatment are described and discussed. Abdominal compartment syndrome is defined as an intra-abdominal pressure >20 mm Hg with evidence of organ dysfunction. At risk patients should be identified in the emergency department and early monitoring of intra-abdominal pressure instituted. Interventions in the emergency department potentially contribute to the development of abdominal compartment syndrome during subsequent phases of care. The need to ensure an early multidisciplinary approach in the management of this complex condition is essential for the best possible patient outcome.