Purpose Acute general surgery in regional Australia is frequently delivered by locum consultant surgeons. The breadth and acuity of this workload across multiple jurisdictions remain under-reported. This study describes the acute general surgery workload managed by a locum consultant surgeon across regional hospitals. Methodology A retrospective descriptive analysis was performed using a prospectively maintained consultant logbook documenting acute surgical procedures, including emergency presentations, undertaken between March and December 2025 across regional hospitals in Queensland, New South Wales, Victoria and South Australia. Procedures were categorised by diagnosis, operative approach and complexity. Results Acute surgical activity was dominated by appendicectomy and abscess drainage, including perianal, pilonidal, axillary and gluteal abscesses. Higher-acuity procedures included exploratory laparotomy, bowel resection, right hemicolectomy, perforated peptic ulcer repair and acute endoscopic intervention for upper gastrointestinal bleeding and food bolus obstruction. Short-term locum placements were characterised by high acute caseloads and limited elective activity, requiring broad procedural competence and independent decision-making across multiple subspecialty domains. Conclusion Locum consultant surgeons provide critical acute general surgery services across regional Australia, managing a wide spectrum of pathology including complex abdominal emergencies. These findings highlight the essential role of locum surgeons in sustaining regional acute surgical care.