Abstract
Acute surgical diseases of the abdomen remain among the leading causes of emergency hospital admission and require rapid, accurate diagnosis to reduce morbidity and mortality. Clinical examination alone is often insufficient to differentiate between conditions such as acute appendicitis, acute cholecystitis, intestinal obstruction, gastrointestinal perforation, acute pancreatitis, mesenteric ischemia, and abdominal trauma, all of which may present with overlapping symptoms of acute abdominal pain. This review summarises the current role of imaging modalities — plain radiography, ultrasonography (including point-of-care ultrasound), computed tomography (CT), CT angiography, and magnetic resonance imaging — in the diagnostic algorithm of the most common acute surgical conditions. Particular attention is paid to disease-specific diagnostic criteria (Tokyo Guidelines for acute cholecystitis, the revised Atlanta classification of acute pancreatitis), the comparative accuracy of ultrasound versus CT, the place of whole-body CT and extended focused assessment with sonography for trauma (eFAST) in polytrauma, and strategies for reducing radiation exposure without compromising diagnostic accuracy. A structured, evidence-based imaging algorithm is proposed to guide the choice of modality in everyday surgical practice.