Background: Lately renewed attention has been given to the abdominal compar
tment syndrome. Despite of this there still remain a lot of controversies w
ith regard to the pathophysiological mechanisms underlying this syndrome an
d the therapeutic options. Methods: Two cases of patients with this syndrom
e are described and the data from animal and human trials concerning the ab
dominal compartment syndrome are presented and discussed. Results: A variet
y of clinical disorders may lead to the abdominal compartment syndrome. It
mainly affects the cardiovascular, pulmonary and renal organ systems. Altho
ugh some clinical effects are clearly described, the exact mechanisms under
lying these changes in humans are incompletely understood. It is still uncl
ear why some patients develop abdominal compartment syndrome and others do
not. The intra-abdominal pressure can easily be assessed by measuring the u
rine bladder pressure, which correlates well with the actual intra-abdomina
l pressure. All authors agree that a decompression of the abdomen by means
of a laparotomy is the treatment of choice for the abdominal compartment sy
ndrome. Which parameters should determine the indication however, remains c
ontroversial, since the correlation between clinical signs and pressure is
not straightforward. Conclusions: The abdominal compartment syndrome is a w
ell-recognised disease entity related to acutely increased abdominal pressu
re. Urgent laparotomy can be lifesaving in some cases. However no single th
reshold of abdominal pressure can be applied universally. Pending further c
linical trials the best therapeutic option seems to be to decompress the ab
domen surgically if the intravesical pressure is 25 mmHg or higher in patie
nts with refractory hypotension, acute renal failure or respiratory failure
due to abdominal distension. (C) 2001 Elsevier Science B.V. All rights res
erved.