We read with interest the recent article by Gracias et al1 describing abdominal compartment syndrome (ACS) in patients undergoing vacuum-pack temporary abdominal coverage (TAC) for abdominal catastrophes. The authors identified ACS in 5 of 20 patients undergoing TAC; despite early recognition and emergency abdominal decompression, recurring ACS in the study procedure group led to a mortality rate of 60%, compared with only 7% in a control group.