Abdominal compartment syndrome (ACS) is a systemic syndrome involving derangement in cardiovascular haemodynamics, respiratory and renal functions as a result of sustained increase in intra-abdominal pressure (IAP) ending in multi-organ failure. It is a life threatening emergency and requires prompt action and treatment. For the last 20 years, there has been more awareness among surgeons and intensivists of ACS being a distinct disease entity but still widespread ignorance prevails. Presentation can be acute, chronic and acute on chronic. Initial diagnosis is clinical, confirmed by measurement of IAP. Treatment is abdominal decompression by laparostomy and delayed abdominal closure. Despite prompt treatment mortality remains high. Awareness among surgeons has increased because laparoscopy has resulted in determination of IAP as a readily measurable quantity and also they have been able to appreciate the benefit of abdominal decompression by performing repeated planned laparotomies for trauma.A medline, pubmed and Cochrane database search was performed and the articles found were cross referenced.Clinical diagnosis is not easy and serial urinary bladder pressure (UBP) monitoring leads to early diagnosis. Treatment is by laprostomy to decompress the abdomen followed by delayed abdominal closure.