A Case of Chronic Constipation due to HTLV-1-associated Myelopathy in which Quality of Life was Improved by Surgical Treatment

Abstract

A 54-year-old woman with HTLV-1 infection had developed progressive myeloparalysis and dysuria, and HTLV-1-associated myelopathy was diagnosed at the age of 32 years. She had been admitted to our hospital in 2019 and treated for severe constipation since then. She was admitted to our hospital for treatment of constipation in January 2020, and she was again referred to our hospital the following May for treatment of abdominal distension and difficulty defecating. Despite medical treatment, abdominal distension due to the accumulation of large intestinal gas as a result of difficulty in defecating and passing gas recurred while she was hospitalized, and she was referred to our department for surgical treatment. Secondary megacolon caused by HTLV-1-associated myelopathy was diagnosed, and total colectomy with colostomy formation was performed. The patient's postoperative course was uneventful, and she was able to control her bowel movements without the use of laxatives or antidiarrheal medication. Preoperatively, she had limited her food consumption out of concern that eating would cause constipation, but her appetite for food improved, and her food intake increased by 40%. Surgical treatment for secondary chronic megacolon causing chronic constipation due to HTLV-1-associated myelopathy improved the patient's quality of life. Surgical therapy may be one option for the treatment of constipation in this condition.