Evaluating an elderly patient with an acute abdomen is a challenging clinical problem. THe diagnosis is more difficult to secure in this age group, because it is difficult to obtain an accurate history, and physical findings are more subtle. The major factors that increase mortality include associated medical diseases, emergent operations, and delay in recognition and treatment of the problem. Patients with widespread malignancy and generalized peritonitis fare poorly, but operative mortality in the geriatric group has improved significantly because of more prompt diagnosis, aggressive resuscitation, precise monitoring, and expedient but definitive procedures. As the proportion of elderly patients in the population continues to rise, it becomes increasingly important to evaluate and manage this problem expediently.