Abdominal Compartment Syndrome

Abdominal compartment syndrome represents a critical condition defined by intra-abdominal hypertension exceeding 20 mmHg alongside new-onset organ dysfunction. Rather than relying on a binary "good number versus bad number" approach, clinicians must evaluate the interplay between abdominal organ volume, space-occupying substances, and abdominal wall compliance. Elevated intra-abdominal pressure triggers a cascade of physiological impairments, including reduced venous return, compromised pulmonary compliance, and decreased renal perfusion, which can initiate a positive feedback loop of worsening visceral edema and ischemia. Diagnosis requires monitoring physiological variables like urine output and peak inspiratory pressure, as clinical examination is often unreliable. Management strategies range from medical interventions like sedation and diuresis to surgical decompression, though clinicians must carefully weigh the risks of aggressive fluid resuscitation against the potential for inducing secondary compartment syndrome and long-term abdominal wall complications.