Second Opinion in Munich: A Romanian Patient Consults a Top Pancreatic Surgeon
Cornelia is from Romania, and for a while her symptoms had been living in that frustrating grey zone - uncomfortable enough to worry about, but not neatly explained by one obvious cause. Her daughter, Irina, contacted us. She wasn’t looking for a “nice reassurance.” She wanted a serious second opinion from a team that deals with pancreatic findings every day.
The patient actually didn’t need to travel. This was a remote second opinion, based on her medical history, lab results, and serial imaging.
Distant Opinion From Munich
The case of Ms. Cornelia was reviewed at University Hospital Rechts der Isar by Prof. Dr. med. Helmut Michael Friess, a leading pancreatic surgeon from Munich. The goal was straightforward: interpret the images, assess risk, and determine whether surgery is necessary or whether careful monitoring is more appropriate.
What the Records Showed
The patient has exocrine pancreatic insufficiency, confirmed by low elastase levels. She also has side-branch IPMN, with a small lesion measuring 4.5 mm. Her MRI scan showed a cystic lesion in the head of the pancreas that appeared to be a side-branch IPMN and, crucially, was stable compared with the previous MRI.
A further MRI also confirmed pancreas divisum, with a ductal anomaly and two entry points into the duodenum. Labs showed mild elevations of lipase and total amylase, while the cancer marker remained within the normal range.
Why Surgery Wasn’t Recommended
This is where the second opinion mattered most: there were no high-risk or worrisome features - no mural nodules, no significant duct dilation, and no rapid growth across serial imaging. Based on these findings, the surgical opinion was clear: surgical intervention is not currently indicated.
Just as importantly, the review suggested that the pancreas is unlikely to be the primary cause of Cornelia’s current abdominal symptoms, even though the cystic lesion is present and should remain under surveillance.
What Prof. Friess Suggested Next
Because Cornelia has pancreas divisum, the opinion included an option that adds useful nuance: a secretin-enhanced MRCP in selected cases.
Unlike a standard scan, which mainly shows structure, secretin-enhanced MRCP can provide functional information about pancreatic juice outflow, helping detect subtle ductal obstruction or delayed emptying when anatomy is atypical.
For follow-up, the recommendation was to continue monitoring with conventional MRCP (and secretin-enhanced MRCP if needed) in 6 to 12 months, focusing on stability and any changes in features over time.
The Part That Could Help Right Away
While surgery wasn’t the plan, treatment still was. Given the confirmed exocrine pancreatic insufficiency, the patient was advised pancreatic enzyme replacement therapy, with follow-up aimed at symptom control, nutrition, and weight maintenance.
Ultimately, Cornelia and Irina received what they were actually asking for: not panic, not delays - just a grounded roadmap. A stable IPMN to watch carefully, a smart imaging strategy tailored to her duct anatomy, and a practical step to improve day-to-day digestion.