Hepatocyte growth factor stimulated angiogenesis without inflammation: differential actions between hepatocyte growth factor, vascular endothelial growth factor and basic fibroblast growth factor

Based on the potent angiogenic effects of hepatocyte growth factor (HGF), therapeutic angiogenesis using human HGF plasmid DNA increased tissue perfusion and reduced symptoms in patients with critical limb ischemia (CLI) in randomized placebo-controlled clinical trials. To explore further the potent angiogenic activity of HGF, the present study compared the effects of HGF, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) on angiogenesis and vascular inflammation. All of HGF, VEGF and bFGF significantly induced the formation of capillary blood vessel and granulation tissue in the rat paper disc model as an in vivo animal model of angiogenesis. However, although HGF, bFGF and VEGF significantly increased the growth of vascular endothelial cells, bFGF alone, but not HGF or VEGF, significantly increased the growth of vascular smooth muscle cells (VSMCs) in the in vitro proliferation assay. In addition, bFGF, but not HGF or VEGF, significantly activated an essential transcription factor for inflammation, NFκB, and gene expression of its downstream inflammation-related cytokines (IL-8 and MCP-1) in VSMCs, accompanied by an increase in the vascular permeability in the rat paper disc model. Thus, the present results indicated that HGF induced angiogenesis without vascular inflammation, different from bFGF and VEGF. These different properties between HGF, VEGF and bFGF might affect the efficiency of therapeutic angiogenesis.

Clinical differences between mass-forming autoimmune pancreatitis and pancreatic cancer

OBJECTIVE

Autoimmune pancreatitis (AIP) needs to be differentiated from pancreatic cancer (PC). We aimed to clarify the findings specific for AIP by comparing the clinical differences between mass-forming AIP and PC.

MATERIAL AND METHODS

We retrospectively compared 36 patients with mass-forming AIP and 60 with PC without metastasis regarding clinical, imaging, serological, histological differences and other organ involvement (OOI). We evaluated the sensitivity, specificity and accuracy of these findings for the differential diagnosis between AIP and PC.

RESULTS

The findings 100% specific for AIP were a capsule-like rim on computed tomography (CT), skipped lesion of main pancreatic duct (MPD) on endoscopic retrograde pancreatography (ERP) or magnetic resonance cholangiopancreatography (MRCP), γ-globulin > 2 g/dl, OOI (extrapancreatic biliary stricture, salivary gland swelling and retroperitoneal fibrosis) and ruling out PC by histopathological findings of endoscopic ultrasonography-guided fine-needle aspiration. The findings over 90% specific were IgG4 > 280 mg/dl (98%), IgG > 1800 mg/dl (97%), maximal diameter of upstream MPD < 5 mm on MRCP (95%) and IgG4 > 135 mg/dl (94%), respectively.

CONCLUSIONS

Clinical, imaging, serological, histological findings and OOI differed between mass-forming AIP and PC. Capsule-like rim on CT, skipped lesion of MPD on ERP or MRCP, IgG4 > 280 mg/dl, and OOI were highly specific findings for AIP. These findings are useful in the differential diagnosis of mass-forming AIP from PC.

Analysis of VH gene rearrangement and somatic hypermutation in type 1 autoimmune pancreatitis

Type 1 autoimmune pancreatitis (AIP) is the pancreatic manifestation of systemic fibroinflammatory disease called immunoglobulin G4-associated systemic disease. Although this inflammatory process is considered to be a disease with an autoimmune mechanism, its pathogenesis still remains unclear. To clarify the characteristics of B cells infiltrating the lesion, we analyzed the immunoglobulin heavy chain variable region (VH) gene rearrangement and somatic hypermutation of invasive lymphoid cells in type 1 AIP (n= 3), in comparison with obstructive pancreatitis (n= 3) as a control. DNA was extracted from the affected inflammatory lesions. After PCR amplification of the rearranged VH gene, the clones were subcloned, and recombinant clones were randomly selected and sequenced. More than 60 clones per case were analyzed. Monoclonal VH rearrangement was not detected in any of the cases examined. There was no VH family or VH fragment specific to type 1 AIP and obstructive pancreatitis. However, the rate of unmutated VH fragments in type 1 AIP (17%) was higher than that in obstructive pancreatitis (5.1%) (P= 0.010). Our study suggests that an increased rate of unmutated or less mutated VH genes may be characteristic of type 1 AIP and might play a role in the development of this disease.

Nuclear translocation of pro-amphiregulin induces chemoresistance in gastric cancer

Amphiregulin (AR) is derived from a membrane-anchored form (proAR) by ectodomain shedding, and is a ligand that activates epidermal growth factor receptor (EGFR). We have recently shown that proAR translocates from the plasma membrane to the nucleus after truncation of 11 amino acids at the C-terminus, which is independent of the conventional EGFR signaling pathway. Although proAR immunoreactivity has reportedly been detected in the nucleus of cancer cells, its biological meaning has never been investigated. This study was performed to investigate the roles of proAR nuclear translocation in human gastric cancer. We constructed proAR truncated 11 amino acids at the C-terminus (proARΔC11) that spontaneously translocates to the nucleus, and established proARΔC11-expression regulatable gastric cancer cells (MKN45, MKN28) using the tet-off system. Using these cells, we found that proAR nuclear translocation significantly induced chemoresistance in vitro and in vivo. Analyzing the relationship between immunoreactive localization of proAR and the clinical outcome for 46 advanced gastric cancer cases treated with chemotherapy, median survival time was 311 days in 16 patients with AR-positive staining in the nucleus and 387 days in 30 patients with AR-negative staining (P < 0.05). The present study demonstrates that proAR nuclear translocation increases resistance to anti-cancer drugs, which might be associated with poor prognosis in human gastric cancer.

A case of IgG4-related sclerosing cholangitis overlapped with primary biliary cirrhosis

IgG4-related sclerosing cholangitis (IgG4-SC) and primary biliary cirrhosis (PBC) can both cause liver dysfunction. While IgG4-SC is associated with IgG4-related diseases such as autoimmune pancreatitis, PBC is associated with various autoimmune diseases. However, there is only one case report of an association between IgG4-SC and PBC, and this association has not been elucidated further. The treatments for these two diseases are different, i.e., corticosteroid treatment is performed for IgG4-SC and ursodeoxycholic acid is given for PBC. We report a case of IgG4-SC overlapping with PBC in a 45-year-old man who was successfully treated by combination therapy with prednisolone and ursodeoxycholic acid.

A case of autoimmune pancreatitis showing narrowing of the main pancreatic duct after cessation of steroid therapy in the clinical course

Autoimmune pancreatitis (AIP) is characterized by irregular narrowing of the main pancreatic duct (MPD), and narrowing of the MPD is an essential criterion for the diagnosis of focal/segmental AIP according to the Japanese diagnostic criteria 2011. We report a 55-year-old man in whom magnetic resonance imaging showed two masses in the pancreatic head and tail and whose pancreatogram was normal at first. However, the two masses changed into diffuse swelling of the pancreas, and diffuse narrowing of the MPD appeared after the cessation of steroid therapy. Finally, we could diagnose this patient as having AIP according to the Japanese diagnostic criteria.

Treatment of Spontaneous Intradural Vertebral Artery Dissections

Spontaneous intradural vertebral artery dissections may cause subarachnoid hemorrhage and often result in devastating damage. Increased use of noninvasive imaging studies has allowed larger numbers of patients to be diagnosed. In addition, intracranial vertebral artery dissection tends to induce multiple lesions affecting both intracranial vertebral arteries recurrently. Although unruptured dissections in this area usually have a benign nature, some authors have reported on the incidence of rupture from this lesion. Once hemorrhage from a dissecting vessel wall has occurred, it needs to be treated in the acute phase because of the high risk of rebleeding resulting in high morbidity and mortality. From December 2004 to July 2010, we managed 47 patients with spontaneous vertebral artery dissection, 31 patients were ruptured and 16 were unruptured. All patients who suffered from subarachnoid hemorrhage were treated with endovascular procedures. Most of the patients with unruptured dissection received medical therapy, but if the aneurysmal dilatation persisted or grew, surgical interventions were performed. Stenting with or without coils was deployed for 13 patients with posterior inferior cerebellar artery involvement at the site of dissection and/or were affected on the dominant side. In some patients, stenting was performed even if they were in the acute phase. For other ruptured patients, internal coil trappings were performed. Six patients died due to severe initial subarachnoid hemorrhage and one patient, who underwent stent deployment with coils for the dominant vertebral artery, with bilateral dissection continuing to the basilar artery died due to rerupture while the next additional coiling was planning. There were two cases of complications related to the intervention. During the follow-up period no bleeding occurred in any of the patients except for the previously mentioned patient. In conclusion, internal coil trapping or stent placement with or without coils was effective in preventing rebleeding of ruptured vertebral artery dissection. If the dissection is unruptured, it is necessary to detect the risk of bleeding with careful watching and when progress appears to be made, patients should be treated promptly. Stent-assisted therapy for preserving the patency of the parent artery and major branches is a promising treatment for vertebral artery dissection, even in the acute stage of subarachnoid hemorrhage. However, the risk of acute rerupture and recurrence remains even with the porous stent placement with or without coils.

Diagnostic procedures for IgG4-related sclerosing cholangitis

BACKGROUND/PURPOSE

IgG4-related sclerosing cholangitis (IgG4-SC) is one of several diseases associated with autoimmune pancreatitis (AIP). However, diffuse cholangraphic abnormalities seen in association with AIP may resemble those seen in primary sclerosing cholangitis (PSC), and the presence of segmental stenosis suggests cholangiocarcinoma. IgG4-SC responds well to steroid therapy, whereas in contrast, liver transplantation is the only effective therapy for PSC, and surgical intervention is also needed for cholangiocarcinoma. The aim of this review was to establish the diagnostic procedures for IgG4-SC.

METHODS

A literature search was conducted, covering English-language articles dealing with IgG4-SC published between 1991 and March 2010. As clinical data on IgG4-SC are limited, the author also took into consideration his own clinical experience with the treatment of IgG4-SC over a period of more than 19 years.

RESULTS

When intrapancreatic stenosis is detected, pancreatic cancer should be ruled out. If multiple intrahepatic stenosis is evident, PSC should be discriminated on the basis of cholangiographic findings and liver biopsy with IgG4 immunostaining. An association with inflammatory bowel disease (IBD) is suggestive of PSC. If stenosis is demonstrated in the hepatic hilar region, cholangiocarcinoma should be discriminated by US, EUS, IDUS, and bile duct biopsy.

CONCLUSION

For diagnosis of IgG4-SC, coexistence of AIP is the most useful finding. However, the most important consideration for clinicians is to be aware of IgG4-SC when encountering patients with obstructive jaundice.

Clinical characteristics of inflammatory bowel disease associated with primary sclerosing cholangitis

PURPOSE

Only a few studies have documented the characteristics of inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC). We aimed to clarify the clinical and histopathological characteristics of IBD associated with PSC (PSC-IBD).

METHODS

Twenty-nine patients with PSC and 60 patients with ulcerative colitis (UC) but without complicating PSC were enrolled in this study. First, the age and sex distribution, affected area, clinical course, number of recurrent attacks, and severity of UC were investigated. Then, mucosal specimens obtained from the right side (cecum and ascending colon), transverse colon, and the left side (descending colon, sigmoid colon, and rectum) during colonoscopy were studied for inflammatory cell infiltration, the presence of crypt abscesses, the degree of goblet cell disappearance, and edema.

RESULTS

(1) The incidence of IBD in PSC patients was 68.9% (20/29). There were two peaks in the age distribution of PSC. Male PSC patients demonstrated a first peak and female patients a second peak. Male PSC-IBD patients were in their teens and 20s making the first peak. Female PSC-IBD patients were in their 50s and 60s making the second peak. The PSC-IBD patents were significantly younger than the patients without IBD (33.6 vs. 58.9 years, p < 0.001). (2) PSC-IBD showed a right-sided predominance colonoscopically. (3) None of the patients had a severe clinical course, and a half of them were asymptomatic. (4) Histopathological examination demonstrated severe inflammatory cell infiltration in the cecum and ascending colon, whereas the degree was mild in the rectum/descending colon.

CONCLUSIONS

PSC-IBD shows characteristic clinical, colonoscopic, and histopathological findings.

Viral level is an indicator of long-term outcome of hepatitis B virus e antigen-negative carriers with persistently normal serum alanine aminotransferase levels

The association between viral level and the long-term outcomes of hepatitis B virus (HBV) carriers who test negative for hepatitis B virus e antigen (HBeAg) but have persistently normal serum alanine aminotransferase levels (PNALT) remains unclear. We examined hepatocarcinogenesis, hepatitis reactivation, predictive factors and the time course of HBV DNA levels during follow-up in 104 HBeAg-negative Japanese carriers with PNALT. During a mean follow-up period of 6.4 ± 3.4 years, 5 patients (4.8%) had hepatocarcinogenesis and 14 (13.5%) had hepatitis reactivation. At 5 and 10 years, the cumulative rates of hepatocarcinogenesis were 2.4% and 9.9%, while those of hepatitis activation were 13.7% and 15.5%, respectively. An HBV DNA level of ≥5 log10  copies/mL was the sole predictor of hepatocarcinogenesis with a univariate analysis. An HBV DNA level of ≥5 log10  copies/mL and an alanine aminotransferase (ALT) level of >20 to ≤40 IU/L were independent predictors of hepatitis reactivation in a Cox model. Because there was no association between hepatocarcinogenesis and ALT activity, the HBV DNA level was considered an essential predictor. In addition, the baseline HBV DNA level was related to the future level and was not subject to wide fluctuations. Our results showed that an HBV DNA level of ≥5 log10  copies/mL predicts subsequent hepatocarcinogenesis and hepatitis reactivation in HBeAg-negative carriers with PNALT. As the baseline HBV DNA level reflects the future level, appropriate clinical management according to the viral level is expected to decrease future risk.

Bleeding tendency and impaired platelet function in a patient carrying a heterozygous mutation in the thromboxane A2 receptor

BACKGROUND

Thromboxane A(2) receptor (TXA(2)R) abnormality appears to dominantly disturb platelet function.

OBJECTIVES

To reveal a molecular genetic defect in a patient with TXA(2)R abnormality and investigate the mechanism for the impaired response to TXA(2).

PATIENT

The proband (OSP-2, PT) was a 7-year-old Japanese girl, suffering from repeated mucocutaneous bleeding.

METHODS AND RESULTS

U46619 (2.5 and 10 μm)-induced platelet aggregation was remarkably impaired in the proband and her father. Immunoblots showed that TXA(2)R expression levels in their platelets were approximately 50% of controls, and nucleotide sequence analysis revealed that they were heterozygous for a novel mutation, c.167dupG in the TXA(2)R cDNA. Expression studies using Chinese hamster ovary (CHO) cells indicated that the mutation is responsible for the expression defect in TXA(2)R. We then examined α(IIb)β(3) activation by employing an initial velocity analysis and revealed that U46619 failed to induce a sustained α(IIb)β(3) and Rap1B activation in the proband. In addition, platelet secretion as monitored by P-selectin expression was markedly impaired in response to U46619 but not to ADP. The interaction between secreted ADP and P2Y(12) has been shown to play a critical role in the sustained α(IIb)β(3) activation (Kamae et al. J Thromb Haemost 2006; 4: 1379). As expected, small amounts of exogenous ADP (0.5 μm) partially restored the sustained α(IIb)β(3) activation induced by U46619.

CONCLUSION

Our present data strongly suggest that the impaired platelet activation in response to U46619 in the heterozygous subject for the TXA(2)R mutation is, at least in part, as a result of the decrease in ADP secretion.

Alpha1,6-fucosyltransferase-deficient mice exhibit multiple behavioral abnormalities associated with a schizophrenia-like phenotype: importance of the balance between the dopamine and serotonin systems

Previously, we reported that α1,6-fucosyltransferase (Fut8)-deficient (Fut8(-/-)) mice exhibit emphysema-like changes in the lung and severe growth retardation due to dysregulation of TGF-β1 and EGF receptors and to abnormal integrin activation, respectively. To study the role of α1,6-fucosylation in brain tissue where Fut8 is highly expressed, we examined Fut8(-/-) mice using a combination of neurological and behavioral tests. Fut8(-/-) mice exhibited multiple behavioral abnormalities consistent with a schizophrenia-like phenotype. Fut8(-/-) mice displayed increased locomotion compared with wild-type (Fut8(+/+)) and heterozygous (Fut8(+/-)) mice. In particular, Fut8(-/-) mice showed strenuous hopping behavior in a novel environment. Working memory performance was impaired in Fut8(-/-) mice as evidenced by the Y-maze tests. Furthermore, Fut8(-/-) mice showed prepulse inhibition (PPI) deficiency. Intriguingly, although there was no significant difference between Fut8(+/+) and Fut8(+/-) mice in the PPI test under normal conditions, Fut8(+/-) mice showed impaired PPI after exposure to a restraint stress. This result suggests that reduced expression of Fut8 is a plausible cause of schizophrenia and related disorders. The levels of serotonin metabolites were significantly decreased in both the striatum and nucleus accumbens of the Fut8(-/-) mice. Likewise, treatment with haloperidol, which is an antipsychotic drug that antagonizes dopaminergic and serotonergic receptors, significantly reduced hopping behaviors. The present study is the first to clearly demonstrate that α1,6-fucosylation plays an important role in the brain, and that it might be related to schizophrenia-like behaviors. Thus, the results of the present study provide new insights into the underlying mechanisms responsible for schizophrenia and related disorders.

Effective Diffusivities of Iodine, Chlorine, and Carbon in Bentonite Buffer Material

Effective diffusivities of iodine, chlorine, and carbon in mixtures of bentonite and sand were determined by measuring the effective diffusivities of common chemical compounds labeled with radioactive isotopes of these elements. For carbon, both inorganic and organic carbon compounds were used in order to consider the variety of chemical forms of carbon possible in a radioactive waste repository. The bentonite content and dry density of the bentonite–sand mixture were varied. Two chemically different aqueous solutions, representing concrete pore water and bentonite pore water, were used to represent different conditions that could affect diffusivity in bentonite buffer material in a hypothetical radioactive waste disposal situation.

The effective diffusivities of iodine, chlorine, and carbon tended to decrease with increasing bentonite content and dry density of the mixture. In the presence of simulated concrete pore water, the effective diffusivities for iodine, chlorine, and carbon in the bentonite mixtures were not higher than those obtained when simulated bentonite pore water was used. Except for some organic compounds, the measured effective diffusivities were lower than that of tritiated water under the same experimental conditions. This was attributed primarily to exclusion of anions from the bentonite pores. The effective diffusivity of carbon depended on its chemical form. The effective diffusivity of the anionic forms of organic carbon tested (carboxylic acids ) was as low as that of inorganic anionic carbon.

Measured effective diffusivities were compared with those calculated using a model based on electrical double layer theory. The theory was applied to calculate distributions of electrolyte ions and diffusing ions in the bentonite pores. The calculated effective diffusivities showed good agreement with the measured values.

Small bile duct involvement in IgG4-related sclerosing cholangitis: liver biopsy and cholangiography correlation

BACKGROUND

IgG4-related sclerosing cholangitis (IgG4-SC) needs to be differentiated from primary sclerosing cholangitis (PSC). In this study, we performed a retrospective study to reveal cases in which liver needle biopsy was useful for differential diagnosis.

METHODS

Nineteen patients with IgG4-SC and 22 patients with PSC were studied. All patients underwent endoscopic retrograde cholangiography and liver needle biopsy. We defined small bile duct involvement of IgG4-SC histologically as damage to the small bile duct associated with infiltration of ≥10 IgG4+ plasma cells per high power field (HPF). Clinicopathological characteristics were compared between IgG4-SC patients with and without small bile duct involvement.

RESULTS

Small bile duct involvement was observed in 5 (26%) of the patients with IgG4-SC. Patients with small bile duct involvement showed a higher incidence of intrahepatic biliary strictures on cholangiography (80 vs. 21%, p = 0.038). Conversely, 4 of 7 (57%) patients with intrahepatic biliary strictures on cholangiography had histologically evident small duct involvement. The number of IgG4+ plasma cells was significantly correlated with the site of the most proximal stricture on cholangiograms (p = 0.021). The number of IgG4+ plasma cells per HPF was significantly higher in IgG4-SC patients with intrahepatic biliary strictures than in those with PSC (13.4 vs. 0.4 cells/HPF, p < 0.001).

CONCLUSIONS

Involvement of small bile ducts is more frequent in patients with intrahepatic biliary strictures on cholangiography, and liver needle biopsy is especially useful for these patients.

Sorption and diffusion of Eu in sedimentary rock in the presence of humic substance

Sorption and diffusion behaviors of Eu in sedimentary rock in the presence of humic substance were investigated. The sedimentary rock collected from 500 m depth of HDB-6 bore hole at horonobe URL site of Japan and Aldrich humic acid (HA) were used in the present study. Sorption behaviors of Eu and the HA on the sedimentary rocks with and without the rock organic matter (ROM) were elucidated as a function of HA concentration. The HA reduced the sorption of Eu on the rock with the increase of HA. Eu and HA sorption on the rock with the ROM was larger than on the rock after removing the ROM, indicating that the ROM plays an important role on the sorption of Eu and HA. The diffusion of Eu in the presence of HA was examined as a function of HA concentration and molecular weight of the HA (∼150 kDa or below 10 kDa) by means of a reservoir depletion test method with the intact rock core of the sedimentary rock. Depletion of Eu concentration in the reservoir was reduced with the increase of HA concentration. On the other hand, slight depletion of HA concentration in the reservoir was observed, indicating that the larger HA molecule diffused less into the rock. From the depletion curve and in-diffusion profile of Eu in the rock, the effective diffusion coefficient, D e, and distribution coefficient, K d, in the intact system were estimated based on the profile fitting of the diffusion data with the conventional simple diffusion-sorption model. It was elucidated that the HA reduced the K d and D e of Eu in the intact system with the increase of HA. The contribution of the HA with smaller molecular weight to both the Eu sorption and diffusion was examined.

Diffusion and sorption of neptunium(V) in compacted montmorillonite: effects of carbonate and salinity

Diffusion and sorption of radionuclides in compacted bentonite/montmorillonite are key processes in the safe geological disposal of radioactive waste. In this study, the effects of carbonate and salinity on neptunium(V) diffusion and sorption in compacted sodium montmorillonite were investigated by experimental and modeling approaches. Effective diffusion coefficients (De) and distribution coefficients (Kd) of237Np(V) in sodium montmorillonite compacted to a dry density of 800 kg m−3were measured under four chemical conditions with different salinities (0.05/0.5 M NaCl) and carbonate concentrations (0/0.01 M NaHCO3).Devalues for carbonate-free conditions were of the order of 10−10–10−11 m2s−1and decreased as salinity increased, and those for carbonate conditions were of the order of 10−11–10−12 m2s−1and showed the opposite dependence. Diffusion-derivedKdvalues for carbonate-free conditions were higher by one order of magnitude than those for carbonate conditions. Diffusion and sorption behaviors were interpreted based on mechanistic models by coupling thermodynamic aqueous speciation, thermodynamic sorption model (TSM) based on ion exchange, and surface complexation reactions, and a diffusion model based on electrical double layer (EDL) theory in homogeneous narrow pores. The model predicted the experimentally observed tendency ofDeandKdqualitatively, as a result of the following mechanisms; 1) the dominant aqueous species are NpO2+and NpO2CO3−for carbonate-free and carbonate conditions, respectively, 2) the effects of cation excess and anion exclusion result in opposite tendencies ofDefor salinity, 3) higher carbonate in solution inhibits sorption due to the formation of carbonate complexes.

Hemosuccus pancreaticus associated with segmental arterial mediolysis successfully treated by transarterial embolization

CONTEXT

Hemosuccus pancreaticus, a rare cause of intermittent upper gastrointestinal bleeding, is usually caused by the rupture of an aneurysm associated with chronic pancreatitis. Segmental arterial mediolysis is a rare non-arteriosclerotic, non-inflammatory vascular disease characterized by vacuolization and lysis of the arterial smooth muscle cells. Segmental arterial mediolysis often causes intra-abdominal hemorrhage through aneurysm rupture. To our knowledge, hemosuccus pancreaticus associated with segmental arterial mediolysis has not previously been reported.

CASE REPORT

A 59-year-old man had suffered from recurrent episodes of epigastric pain and melena. Laboratory data showed mild anemia and an elevated serum amylase level. Upper gastrointestinal endoscopy revealed bloody pancreatic juice exuding from the papilla of Vater. There were no findings suggestive of chronic pancreatitis, such as pancreatic calcification, irregularity of the pancreatic duct and atrophy of the pancreas. Contrast-enhanced computed tomography revealed a large fusiform aneurysm of the middle-distal splenic artery, and dissection of the proximal splenic artery and celiac artery. Leakage of contrast medium from the aneurysm into the main pancreatic duct was also evident. Angiography clearly revealed a fusiform aneurysm of the splenic artery. This was managed successfully by transarterial coil embolization and the patient has subsequently shown no recurrence of epigastric pain or melena.

CONCLUSION

Segmental arterial mediolysis is a very rare cause of hemosuccus pancreaticus not associated with chronic pancreatitis. Transcatheter arterial embolization is useful for treatment of ruptured aneurysm associated with segmental arterial mediolysis.