Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) of >20 mmHg with the presence of an attributable organ failure. Intra-abdominal hypertension (IAH) may contribute to splanchnic hypoperfusion, intestinal perforation and multiple organ failure. A major cause of morbidity and mortality after ruptured abdominal aortic aneurysm (rAAA) is ACS, which is estimated to develop in 20% of the patients. In the largest series of patients with rAAA treated with endovascular aneurysm repair (EVAR), mortality of ACS patients was 30%. ACS and intestinal perforation are identified as predictive factors for increased ICU mortality and morbidity, for which reason future vigilance and appropriate management of them remains critically important in rAAA. The lesson to be learned from this case is that DCO and conservative fluid strategy should be taken timely to avoid the subsequently ACS. DCO is conducted to break the reinforcing cycle of hypothermia, coagulopathy, and acidosis after catastrophic intraabdominal vascular events. Efforts should be made to find a balance between giving sufficient fluid therapy to maintain hemodynamic stability and organ perfusion while avoiding overzealous volume administration. This may be achieved by a neutral or slightly negative fluid balance. It is anticipated that these important concepts need to be even wider application in the future.