Objective: To present a case of spontaneous perforation of colon. Introduction: Spontaneous perforation of colon (SPC) is defined as sudden perforation of apparently healthy colon in absence of diseases or injury. SPC is an uncommon clinical entity which is seldom reported in literature, less than 100 cases were reported. Case report: A 82-year-old gentleman presented to emergency room (ER) with acute abdominal pain, for few hours duration. Pain started paraumbilically with sudden onset and then with increasing intensity became generalized. It was associated with nausea and vomiting. On general examination, he was conscious, alert. His vital signs: afebrile, pulse: 106/m, B.P: 140/100, local examination showed generalized abdominal tenderness & guarding with absent intestinal sounds. P.R. exam showed remnants of stool with blood stain on gloves, no masses. Computerized tomography (CT) abdomen showed perforation of cecum. He was taken to operation room (OR) and right hemicolectomy was done. Post operative period was uneventful and he was discharged in good health. Conclusion: SPC is a serious condition with high morbidity and mortality due to delay in diagnosis and management so, every effort should be made to make diagnosis especially in elderly and prompt surgical intervention should be done.

Pneumoperitoneum refers to presence of free air within the peritoneal cavity, “Pneumoperitoneum induced Peritonitis” is synonymous of surgical pneumoperitoneum, as the leak of air and visceral contents contaminates the peritoneal cavity, producing peritonitis which mandates surgery. This entire pneumoperitoneum may result from inflammatory conditions, traumatic injury, neoplasia, anastomotic leak and vascular causes.The objectives of this study is to determine the incidence of Pneumoperitoneum-induced Peritonitis (surgical pneumoperitoneum) in emergency exploratory laparotomies, to identify the common anatomical sites of perforations and to review the pathological etiology of these cases.Review of 450 cases of emergency exploratory laparotomy cases performed in King Abdulaziz University Hospital from January 2011 to December 2015, among them 131 cases with radiologically documented pneumoperitoneum were selected to be involved in the study of surgical pneumoperitoneum, the anatomical site of perforation and the exact underlying pathology were documented.29% of exploratory laparotomy cases were found to have pneumoperitoneum, mainly in the in the gastroduodenal region, inflammatory conditions as peptic ulcer disease or diverticulitis were the underlying cause of most of perforations.Pneumoperitoneum frequently indicates bowel injury or disease, hence it is called surgical pneumoperitoneum, Perforations are commonly found in gastro-duodenal area, the inflammatory conditions are responsible for the vast majority of cases, however presence of air with intact bowel, is called Non-Surgical or spontaneous Pneumoperitoneum, which has to be approached conservatively.

BackgroundLiver dysfunction is a topic of global concern with many advancing therapies being researched. Though vitamin D takes a center place, other therapies especially nutritional are also gaining ground. Vitamin D has gone beyond its role in skeletal disorders by showcasing its associations in other metabolic dysfunctions too.ResultEpidemiological evidences show a correlation between the status of vitamin D and different forms of cancer. Vitamin D receptors and alterations in gene expression appear decisive in the development of chronic liver disorders. Nutritional status therefore plays a significant role in avoiding the complications related to liver dysfunctions, making it mandatory in maintaining vitamin D sufficiency in the body. Therapies with omega-3 fatty acids, antioxidants, amino acids, steroids also render benefits which could be further explored. Recent research on the progression of certain forms of liver cancer using vitamin D analogs like Seocalcitol EB 1089 has shown good promise.ConclusionThe anti-inflammatory and immuno- regulatory properties of vitamin D makes its analogs, suitable candidates of better choice for the prevention and treatment of liver disorders and cancer.

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Introduction: Appendicitis is the most common abdominal emergency worldwide. Many standard laboratory tests are used to diagnose appendicitis, but there are no specific indicators. Some studies suggested that hyperbilirubinaemia correlates with appendiceal perforation. The objective of this study is to review the bilirubin level in patients with acute appendicitis (non-perforated appendix) and in those with a perforated appendix, to assess the efficacy of using the bilirubin level to predict if patients will have a perforated appendix. Patients and Methods: This is a retrospective study of 269 patients who had undergone appendectomy from June 2008 to September 2016 in King Abdul Aziz University Hospital. These cases were classified histologically as acute non-perforated appendicitis and perforated or gangrenous appendicitis. The bilirubin levels of the two groups were compared in terms of the mean, sensitivity, and specificity.