Severe acute pancreatitis (SAP) can induce intra-abdominal hypertension, which has an adverse effect on the function of urinary, circulatory, digestive and neurological system, and finally leads to abdominal compartment syndrome (ACS) if patients were not timely treated. This article focuses on the close relationship between SAP and ACS, which included the definition, classification, pathogenesis of ACS and its pathophysiologic effects on other important organs. The different types and indications of surgical interventions of ACS were discussed in detail. For SAP patients complicated with ACS, urgent open abdomen is important to decrease the abdominal pressure and to prevent the incidence of multi-organ dysfunction syndrome. Complications after open abdomen, such as intestine fistula,abdominal sepsis, intestinal dysfunction and abdominal deficit,should be managed prudently.