Syrian Doctors Perform Paraganglioma Resection Despite US Sanctions

Dr. Schauki Mahmoud led the surgical team at Al Basel Hospital in Syria's first resection of a serious retroperitoneal paraganglioma.

Syrian doctors have performed a paraganglioma resection, miraculously, and despite inhumane western sanctions. A medical team at the Al Basel Hospital in Tartous successfully removed a neuroendocrine tumor from a 41-year-old woman. Schauki Mahmoud led the 5-1/2 hours procedure during which the 9 x 7.3 x 6.5 centimeter mass was completely excised, despite adherence to the duodenum, and being precariously close to the aorta.

SANA recently interviewed lead surgeon, Dr. Mahmoud (English, and Arabic). He described the young patient who presented with “left flank discomfort” and whose only significant past medical history included three years of anxiolytics for management of panic attacks accompanied by headaches and palpitations, including bouts of tachycardia (a rapid heart rate, though in normal sinus rhythm).

The patient was admitted for a full work up. Due to the economic blockade against Syria, the upper gastrointestinal endoscope only went as far as the 3rd duodenum segment. Those results were normal.

Radiographic testing with isotopic intravenous and oral medication contrast, however, showed a retroperitoneal mass. Blood work showed slight anemia, slight hyperglycemia, and normal hormonal results. A 24 hour urine collection to test for catecholamines was also negative.

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Based on the available test results, the hospital’s team had reason to suspect a gastrointestinal duodenal stromal tumor (GIST), and made plans to surgically remove it after a 14 day regimen of anti-hyperglycemics and anti-hypertensives.

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When the Al Basel physicians opened up the patient, they discovered a retroperitoneal mass, adherent to the 4th segment of the duodenum (not visualized via endoscope which only got as far as the 3rd), quite near to the aorta and kidney.

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Highly vascularized tumor was successfully removed.

Intraoperatively, the patient went into hypertensive and catecholamine crises, bottomed out, lost two liters of blood, was transfused with 6 units of packed red blood cells, had her anesthesia increased, was given vasodilators (for hypertensive crisis) and then vasocontrictors (to halt the bottoming out), in addition to crystalloid (normal saline) fluids to expand volume.

The procedure was nothing short of miraculous, with the miracle being the hard work of the expert team, and of surgical and medical knowledge. The precise diagnosis of paraganglioma was confirmed via immunohistochemical staining.

The study — A Rare Serious Case of Retroperitoneal Paraganglioma Misdiagnosed as Duodenal Gastrointestinal Tumor — has been published in the peer-reviewed BMC Surgery.

For laypersons interested in reading the riveting report, Syria News provides an efficient visual glossary:

We have seen no western news report on this major surgical wonder. No documentary will be made about it; such things are left to the Hollywood 5th column thugs who glorify unhospitals, who cheer the unlicensed, criminal, Mengele sadists who gloat over performing illegal surgeries without anesthesia.

The author bows in respect to the medical team of Schauki Mahmoud, Massam Salami, and Hosam Salman, who saved the life of a 41 year old mother of three, under arduous conditions.

Miri Wood

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