The analysis of the results of treatment of 397 patients with acute colonic obstruction and acute destructive pancreatitis has done, including 201 patients applied differential treatment policy based on indicators of intra-abdominal pressure. A complex of diagnostic procedures allowing to suspect and diagnose early intra-abdominal hypertension syndrome. Given the nature of complications, the level of intra-abdominal pressure, the severity of patients, the adequacy of decompression techniques suggested 4 varints to complete the surgery.