Background Abdominal compartment syndrome and splenic complications are common in patients with acute severe infected necrotizing pancreatitis. These conditions increase the morbidity and mortality in patients with acute severe pancreatitis. Case presentation this case report describes a patient with acute severe infected necrotizing pancreatitis who developed abdominal compartment syndrome and diffuse splenic infarction. Patient was managed with laparotomy with sequential debridement and Bogota bag closure and splenectomy. Conclusion Abdominal compartment syndrome is a life threatening condition occurring in patients with severe acute pancreatitis. Laparotomy and decompression can be lifesaving in these patients. Besides, splenic infarction can also occur in these patients. Splenectomy should be done in patients with diffuse splenic infarction.