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The pressure in the abdominal cavity (IAP, usually 5–7 mmHg) can be measured via an indwelling urinary catheter (trans‐bladder technique) [56]. AP is associated with several conditions and complications that may raise IAP, such as retroperitoneal collections, paralytic ileus, visceral edema, ascites, and bleeding. A significant increase in IAP may be associated with damage to organs of the abdomen due to ischemia, with restriction to lung expansion and finally to organ failure, so IAP must be monitored in all patients with AP and organ failure. Abdominal compartment syndrome has been defined as a sustained IAP above 20 mmHg that is associated with new organ dysfunction or failure [56].

In the case of abdominal compartment syndrome in a patient with AP, several conservative measures should be attempted to decrease IAP, aiming to improve organ failure. Nasogastric and/or colonic decompression and neuromuscular blockade with mechanical ventilation may be the first steps [57]. If organ failure/dysfunction persists and IAP is still high, percutaneous drainage of collections may be helpful [58]. In case of sustained increased IAP and organ failure, abdominal decompression surgery (e.g. midline laparostomy) can be attempted [57], but there is a lack of randomized controlled studies comparing such an aggressive strategy with a more conservative one.