Introduction: Acute abdomen, characterized by abrupt onset of severe abdominal pain, necessitates immediate medical attention and often surgical intervention. The choice of optimal surgical strategy and improved patient outcomes largely depend on the precision of pre-operative diagnostic imaging. This study evaluates the correlation between pre-operative imaging findings and per-operative findings in patients presenting with acute abdomen. Methodology: This study, conducted in the Department of General Surgery at Chettinad Hospital and Research Institute from January 2023 to January 2024, involved 50 cases of acute abdomen. Inclusion criteria included patients aged 18 to 60 presenting with a clinical diagnosis of acute abdomen. Exclusion criteria included pregnancy-related acute abdomen, gynecological causes, patients managed conservatively, and those not consenting to surgery. Data collection included patient history, physical examination, and radiological investigations such as plain chest radiographs, erect abdominal radiographs, abdominal ultrasonography (USG), and computed tomography (CT) scans. Statistical analysis was performed on the collected data.