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Key Clinical Message: This paper highlights that diagnosis and treatment of one ectopic pregnancy does not rule out the happening of a second ectopic pregnancy in the same patient concurrently, especially if the patient has rising β‐hCG and persistent symptoms. Bilateral tubal pregnancy (BTP) is the most uncommon form of tubal ectopic pregnancy. Complications can lead to maternal morbidity and mortality. We reported a case of left tubal pregnancy and the patient underwent laparoscopic salpingostomy. During the follow‐up, the contralateral ectopic pregnancy was discovered and treated with MTX. [ABSTRACT FROM AUTHOR]

Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagnosis and emergency treatment save patient life. Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative. Conclusion: Stomach and duodenal perforation should be considered in patients without peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events. [ABSTRACT FROM AUTHOR]

Context: Acute abdominal pain is one of the most common complaints of patients admitted to emergency units. This study aimed to propose a new approach to abdominal pain by designing a more structured diagnostic workup for physicians., Evidence Acquisition: A comprehensive review of relevant articles and algorithms presented in books and websites was conducted. Approaches which were relevant to the study concept, were selected., Results: Seven algorithms were introduced with respect to the site of abdominal tenderness. The mainstay of these algorithms was differential diagnosis of the tenderness site., Conclusion: Based on the findings, the designed approach can prevent confusion among physicians and reduce requests for many unnecessary paraclinical tests, which delay the final diagnosis and impose unacceptable costs on patients and healthcare systems., Competing Interests: Conflict of interest None declared., (© 2020 Tehran University of Medical Sciences.)

Purpose: The main strategy in inguinal hernia repair is mesh hernioplasty (specially prolene mesh). Pain in anterior femoral, inguinal and scrotal areas, mainly due to sensory nerve injury in the very regions and vas deferen injury are the main complications reported following repairing inguinal hernia. In this study we decided to use semiliquid silicone in order to form it in an in-vivo prosthesis production method to perform hernioplasty., Methods: In this technique, silicone was produced through Room Temperature Vulcanization (RTV) technique, which is feasible in the room temperature. The produced semiliquid polymer was shaped in the inguinal canal in six cadavers., Result: While the prostheses adequately covered all the anatomic area of the canal with an acceptable thickness in all of the cases, a satisfactory shape was developed in four cases. While 15 - 20 cc of silicone was needed to cover all anatomic areas properly, the hardness equal to 15 was achieved after curing process., Conclusion: New silicone prosthesis forms satisfyingly in the inguinal canal and can protect it by encapsulation mechanism. It is soft with no risk of damage to the nerves or vas. It is inert and has no toxicity to the adjacent tissue. This technique of silicone remodeling can also be used in other fields of surgery such as plastic or vascular surgery.