[Medical team's struggle with financial abuse in the corresponding -Limitation of the adult guardianship system: A case report].

Upon diagnosis of dementia, a 93-year-old woman was unable to manage her finances. Her nephew illegally spent her money, which was considered as financial abuse.The public office forcibly admitted her to our hospital as a legal measure. After five years, she attained the terminal stage owing to eating disorders.While the medical team was preparing for end-of-life care, the patient's guardian of adult had sent informed consent form to perpetrator who was accused of financial abuse because the guardian had no authority of decision-making.On learning about the whereabouts of his aunt, the perpetrator contacted the medical team which then attempted to resolve the conflict of opinions.However, obtaining the family's consent emerged into an exhaustive and stressful process for the staff.In the present system, wherein the guardians of adult have no authority over medical treatment policy, they should, at least, participate in the discussion of future opinions and cooperate with a constructive attitude.In contrast, the medical team should offer better information to the guardians of elderly patients to devise a proper treatment plan.

A case of pancreaticoduodenal artery aneurysm causing pancreatic pseudotumour and duodenal obstruction.

This case report describes a ruptured pancreaticoduodenal artery aneurysm (PDAA) causing pancreatic pseudotumour and duodenal obstruction. A 59-year-old man was referred to our hospital with a chief complaint of frequent vomiting without abdominal pain. Because a mass lesion 10 cm in diameter was palpated in the right para-umbilical region and found in the head of the pancreas on computerized tomography (CT) and ultrasonography, malignant tumour of the pancreas or tumour-forming pancreatitis was strongly suspected, and further examination was performed.Magnetic resonance imaging (MRI) results suggested subacute haematoma inside the mass. On angiography, an aneurysm 8 mm in diameter was found in the posterior superior pancreaticoduodenal artery (PSPD). Since an ultrasound-guided percutaneous needle biopsy from the solid part of the mass indicated no malignancy, the lesion was considered an inflammatory pseudotumour in the head of pancreas due to ruptured aneurysm. Bypass surgery was planned, but the tumour shrank significantly with conservative treatment. Obstruction disappeared completely without surgery 4 weeks after the first symptom.