Background: Abdominal compartment syndrome (ACS) refers to multi-organ dysfunction caused by intraabdominal hypertension. A devastating condition that can lead to a 100% mortality if not treated. ACS is often underrecognized in the emergency department (ED) because it mostly affects patients who are critically ill and admitted in intensive or surgical care units. Case Report: In this paper, we report a case of a young patient with a history of recent surgical intervention but no past medical history who presented with recurrent cardiac arrest that failed to respond to aggressive management. It was initially unrecognized, but later ACS was considered in the differential and the patient was treated accordingly and eventually revived and had good neurological outcome. Conclusion: ACS is a rare but critical diagnosis that might be under recognized in the ED. With high rates of ED turnover, it is essential for ED clinicians to be aware of this disease and have a high index of suspicion about it.

Keywords: Keywords: ROSC, Gastric sleeve surgery, Intra-abdominal hypertension, Laparotomy, Post sleeve complications.