In a 12-month prospective study 370 patients with acute abdominal pain were admitted to a single surgical unit of a large teaching hospital. The most common diagnoses were appendicitis (23.5 percent), Non-specific abdominal pain (NSAP) (21.4 percent), acute intestinal obstruction (10.8 percent), gynaecological causes (9.5 percent, and peptic ulcer (9.2 percent). Emergency operations were performed in 146 patients (39.5 percent). Appendicectomy was the commonest operation (77 cases or 52.7 percent) and there was a high incidence of complicated appendicitis (41.6 percent). Eleven patients (3.0 percent) died within 30 days of admission (8 postoperative and 3 non-operative deaths). The clinical spectrum of the acute abdomen in this study shows that surgeons in developing countries are not facing surgical challenges similar to those of their counterparts in developed countries and the most important diagnostic distinction surgeons in both localities have to make is that between acute appendicitis and non-specific abdominal pain.