Post-COVID accidental Mixed-Duct IPMN? Straight to Whipple procedure?

Posted by new2dis @new2dis, 1 day ago

Hi all, a few questions I hope I can get answered here... fully accepting that individual circumstances all differ and this is just an online forum. Sorry if I won't reply to you all...

BACKGROUND
1) healthy, in early middle-age
2) contracted COVID-19 mid-last year [no vax]
3) CT scan = fatty liver, 5mm gallbladder defect plus accidental, possible IPMN finding
4) asymptomatic, with only a few, sharp episodes of abdominal pain in last 3 years
5) EUS = Mixed-Duct IPMN with a "high-risk" side-branch lesion in the head [specifically: pancreatic duct dilated throughout (6mm head, 5mm body, 3mm tail) with fleck mucin in the head; 15mm side-branch lesion with thick wall and mossible mural nodule (mucin within); but pancreatic parenchyma and biliary duct normal]
6) MRCP = diffuse dilatation more suggestive of fibrotic stricture than intraductal IPMN, with no cholangiocarcinoma, ductal or periductal lesion seen
7) ERCP = moderate 6mm dilatation of ventral pancreatic duct in the head, with mucus and abnormal papillary lesion seen only at the level of the duct in the pancreatic duct... but still reported as Mixed-Duct IPMN diagnosis?
8) Biopsy = No high-grade dysplasia or invasive carcinoma identified (based on limited sample)
9) Blood tests, including tumor markers, all normal
10) But at last consultation, suddenly advised to undergo Whipple procedure.

QUESTIONS
A) Given byopsy and blood test results, no cancer symptoms, and ERCP results... are they wrong to still consider condition as Mixed-Duct IPMN?
B) Is Whipple procedure an overly conservative and pre-emptive approach at this point? Alternatives?
C) How prominent is diabetes following Whipple procedure? Being healthy and active, major post-operative issues or changes to worry about?
D) Any measure to prevent the condition worsening?

Thanks in advance 🙂

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Teresa, Volunteer Mentor | @hopeful33250 | 1 day ago

Hello @new2dis and welcome to Mayo Connect. You are asking good questions. As you already know, the members of Mayo Connect do not represent medical professionals, we are patients like yourself. That said, many of us have a diagnosis of IPMN, fatty liver, etc.

Before you consider a Whipple procedure, I would encourage you to get a second opinion. If you are able to consult with Mayo Clinic that would be great place to gather information and a second opinion. Here is a link with appointment information, http://mayocl.in/1mtmR63.

If, for any reason, an appointment at Mayo is not possible, I would recommend that you get a second opinion at a Pancreatic Center of Excellence. Here is the website for the National Pancreatic Cancer Foundation, https://www.npcf.us/cancer-centers/. If you contact this organization, they will probably be able to help
you find a pancreatic specialist in your area.

One of the most important things you can do now, is to get another professional opinion and some education about this issue. I look forward to hearing from you again. Will you continue to post with updates?

markymarkfl | @markymarkfl | 23 hours ago

C) How prominent is diabetes following Whipple procedure? Being healthy and active, major post-operative issues or changes to worry about?

My non-fasting glucose was pretty high at the time of my initial PDAC diagnosis. Pancreas was obviously not functioning properly... was given some counseling, insulin, and a Dexcom.

Post-Whipple, definitely diabetic. Decent control if I exercise and watch what I eat, but can't avoid some sugar spikes w/o insulin.

PEI (Pancreatic Enzyme Insufficiency) is another outcome of having your pancreas chopped in half. You may need enzyme replacement (e.g., Creon) to digest food properly after a Whipple.