abdominal compartment syndrome ( acs ) is defined as a sustained intra - abdominal pressure ( iap ) associated with new organ dysfunction / failure . acs or intra - abdominal hypertension ( iah ) may occur after intra - abdominal events such as surgery , trauma and peritonitis . acs progression can be life threatening with multiple organ dysfunction in the respiratory , cardiac , renal and gastrointestinal systems . emergency laparotomy for abdominal decompression is often considered in patients with acs , , , , , , . we report the first known case of acs owing to simple elongated sigmoid colon , without volvulus or peritonitis . an 86-year - old man presented at our hospital for chronic constipation with elongated sigmoid colon . he did nt take any medicine that could slow up the bowel movements , as anti - depressive drugs or another . moreover , the frequency of his admission to hospital had increased up to once a month . at each admission , he was treated with colonoscopy to remove sigmoid colon gas , subsequently becoming symptom - free . the patient has developed several symptoms of dementia along with his aging , which have led to poor performance status . recently , on admission , he suffered from severe abdominal distension with hypotension , tachycardia and tachypnea twice a week . iap was measured using the trans - bladder method and showed elevated iap of 21  mmhg . abdominal x - ray showed a large quantity of sigmoid colon gas and elevated bilateral diaphragm ( fig . however , laboratory investigations were unremarkable for blood cell count , biochemical factors and blood gas . contrast - enhanced computerized tomography ( ct ) scan demonstrated that the sigmoid colon was only elongated at the extremities and dilated with the large quantity of gas , and apparent volvulus was not observed . meanwhile , the patient s inferior vena cava had collapsed because of the dilated colon ( fig . , we decided to decompress colon gas by colonoscopy , instead of performing emergency laparotomy . however , we decided to perform elective surgery the day after the interventional decompression by colonoscopy . on laparotomy , his sigmoid colon was approximately 100  cm in length , but his rectum was normal . the dilated sigmoid colon was successfully resected , and the subsequent reconstruction was done by functional end - to - end anastomosis ( fig . histological examination showed normal sigmoid ganglion cells , and the patient was diagnosed with simple elongated sigmoid colon without volvulus and idiopathic megacolon . an 86-year - old man presented at our hospital for chronic constipation with elongated sigmoid colon . he did nt take any medicine that could slow up the bowel movements , as anti - depressive drugs or another . moreover , the frequency of his admission to hospital had increased up to once a month . at each admission , he was treated with colonoscopy to remove sigmoid colon gas , subsequently becoming symptom - free . the patient has developed several symptoms of dementia along with his aging , which have led to poor performance status . recently , on admission , he suffered from severe abdominal distension with hypotension , tachycardia and tachypnea twice a week . iap was measured using the trans - bladder method and showed elevated iap of 21  mmhg . abdominal x - ray showed a large quantity of sigmoid colon gas and elevated bilateral diaphragm ( fig . however , laboratory investigations were unremarkable for blood cell count , biochemical factors and blood gas . contrast - enhanced computerized tomography ( ct ) scan demonstrated that the sigmoid colon was only elongated at the extremities and dilated with the large quantity of gas , and apparent volvulus was not observed . meanwhile , the patient s inferior vena cava had collapsed because of the dilated colon ( fig . , we decided to decompress colon gas by colonoscopy , instead of performing emergency laparotomy . however , we decided to perform elective surgery the day after the interventional decompression by colonoscopy . on laparotomy , his sigmoid colon was approximately 100  cm in length , but his rectum was normal . the dilated sigmoid colon was successfully resected , and the subsequent reconstruction was done by functional end - to - end anastomosis ( fig . histological examination showed normal sigmoid ganglion cells , and the patient was diagnosed with simple elongated sigmoid colon without volvulus and idiopathic megacolon . acs was first reported by kron et al . in 1984 , who described its pathophysiology resulting from iah secondary to aortic aneurysm surgery . acs is defined as a sustained iap  >  20  mmhg that is associated with new organ dysfunction / failure . elevated iap possibly induces adverse effects on pulmonary , cardiovascular , renal , splanchnic , musculoskeletal and central nervous system physiology , , , , , , . for example , iap causes a direct reduction in cardiac output resulting from the decreased cardiac venous return from the inferior vena cava and portal vein . the elevated diaphragm causes reductions in total lung capacity , functional residual capacity and residual volume . the disordered physiology following iah may result in a clinical syndrome with significant morbidity and mortality . the correct diagnosis of acs onset and timely appropriate intervention are required for optimal outcome . although the exact incidence of acs has not been established , studies have increasingly examined acs in certain groups . abdominal surgery , major trauma , volvulus , acute pancreatitis , liver dysfunction , sepsis , shock , obesity and age have all been reported as risk factors for acs , . in the present case , we diagnosed acs originating from a simple elongated sigmoid colon , because we observed abdominal distension with elevated iap , hypotension , tachycardia and tachypnea . the mental and physical functions of this patient were gradually declining owing to his progressive dementia . iah or acs may become more common with a growing aging population , particularly in japan . several previous reports have demonstrated iah and acs triggered by sigmoid volvulus or peritonitis . however , ours is the first case of acs based on simple elongated sigmoid colon . this report may serve as a warning case for surgeons that acs may occur even in simple elongated colon without volvulus or peritonitis . we described for the first time a case of acs originating from an elongated sigmoid colon in an elderly man . considering the growing aging population and higher likelihood of acs , surgeons will need to precisely diagnose acs and determine the optimal time for surgery . written informed consent was obtained from the patient for publication of this case report and accompanying images . a copy of the written consent is available for review by the editor - in - chief of this journal on request . yk has been involved in drafting of the manuscript and revised it critically for important intellectual content .
highlightsabdominal compartment syndrome may result in a clinical syndrome with significant morbidity and mortality.intra-abdominal events , obesity and age have been reported as risk factors.we report a first case of abdominal compartment syndrome in an elderly patient without other risk factors.abdominal compartment syndrome may become more common with a growing aging population.surgeons will need to precisely diagnose and determine the optimal time for surgery .