Postinjury (primary) abdominal compartment syndrome (ACS) was described more than 15 years ago as severe abdominal distension with high peak airway pressures, CO(2) retention, and oliguria, which led to unplanned re-exploration after damage-control laparotomy. Later, a more elusive type of ACS was recognized, which develops without abdominal injuries (secondary ACS). Both syndromes were recently characterized, their independent predictors were identified, and preventive strategies were developed to reduce their incidence. Once viewed as a syndrome with almost uniform mortality, systematic preventative strategies and therapeutic efforts have reduced the prevalence, morbidity, and mortality of the syndrome. This review was designed to summarize the recent advances in the management of ACS, to classify the currently available evidence, and to identify future directions of research and clinical care.