Background <p>Inhaled nitric oxide is a selective pulmonary vasodilator commonly used to treat pulmonary hypertension and right ventricular failure. However, its effectiveness in treating right ventricular failure secondary to hypercapnia caused by abdominal compartment syndrome has not been well described.</p> Case presentation <p>This case describes a patient who developed severe hypercapnia and acute right ventricular failure due to abdominal compartment syndrome following massive intraoperative hemorrhage. Elevated intra-abdominal pressure impaired the respiratory mechanics, resulting in alveolar hypoventilation, hypercapnia, and acute pulmonary hypertension. Respiratory and circulatory failures progressively worsened. Administration of inhaled nitric oxide was associated with a rapid improvement in right ventricular afterload surrogates, leading to improved right ventricular output and enhanced carbon dioxide elimination, with concomitant improvement in systemic hemodynamics.</p> Discussion <p>Inhaled nitric oxide may serve as an effective rescue therapy for hypercapnia-induced pulmonary hypertension and acute right ventricular failure associated with abdominal compartment syndrome.</p>