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A 47 years old Saudi male was admitted to king Khalid hospital with complaints of constipation and abdominal distension. Abdominal examination showed as a case of intestinal obstruction. He was fully evaluated and was treated first conservatively, until all investigative study confirmed as huge small bowel dilatation (mainly jejunum). Exploratory laparotomy confirmed small bowel tumor and on histology an adenocarcinoma. The introduction, history and research paper will also be discussed in this report.

Necrotising fasciitis is a rapidly progressive inflammatory infection of the fascia with secondary necrosis of the subcutaneous tissue. The speed of spread is directly proportional to the thickness of the subcutaneous layer. It moves along the fascial plane. We are presenting a case report of 27 years old Saudi female with status post Lower segment caesarian section of 10 days’ duration presented with bluish discoloration of the lower anterior abdominal wall around the surgical scar with necrotic patches and surrounding induration with foul smelling discharge from the one pocket within this area. She underwent successful simultaneous incision and wide debridement of gross necrotic tissues; together with evacuation of the pus followed by secondary closure. Both general and plastic surgical teams were involved. Patient made uneventful recovery and discharged home in good condition.

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Background: The objective of the study was to determine the outcome of secondary peritonitis in non-traumatic small and large bowel perforation in a secondary care hospital in the region of Ha’il, Kingdom of Saudi Arabia (KSA).Methods: This prospective study was conducted in a surgical unit of King Khalid Hospital, Ha’il Kingdom of Saudi Arabia, from 01 October 2013 to 30th June 2014. 30 patients were admitted through emergency room (ER). Every patient was enquired a detailed history about abdominal distension, abdominal pain, fever, constipation, vomiting, and gut motility. Clinical examination of the patient was done. Baseline investigations along with chest radiograph posterio-anterior (PA) view, abdominal radiograph with erect and supine views and ultrasound whole abdomen were included. All patients landed in the ER with peritonitis due to gastrointestinal perforation, regardless of their sex and age, were included. Peritonitis of primary cause or due to trauma, corrosive ingestion and anastomosis leak were excluded. Follow up of all the patients was done. Data was analyzed through SPSS software 16.Results: Out of 30 patients, 23 (76.66%) were male and 7 (23.33%) were female. Mean age 36.28±2.3 years. 80% presented with abdominal pain. Pneumoperitoneum on chest X-Ray was found in 21 (70%) patients. Duodenal perforation was the most common reason of peritonitis in 14 patients (46.66%). Surgical site wound infection is the commonest complication in 16 patients (53.33%).Conclusions: In conclusion, the outcome of secondary peritonitis in our Eastern population is perforation of the upper gastrointestinal tract and small bowel as the documented common cause, and wound infection as the commonest complication.