This document summarizes a case of abdominal compartment syndrome in a 26-year-old man following a road traffic accident. He developed increased ventilatory requirements, metabolic acidosis, and oliguria despite resuscitation, and was found to have a tense abdomen. Measurement found his intra-abdominal pressure to be elevated at 28cmH20, confirming abdominal compartment syndrome. He underwent decompressive laparotomy, which reduced his ventilatory needs. He developed subsequent complications but ultimately recovered with abdominal closure and pelvic fixation.