Shahroud University of Medical siences Shahroud Journal of Medical Sciences 2423-6594 12 2 2026 05 01 Comparison of preoperative imaging findings with intraoperative findings in surgically treated acute abdomen patients, a single center Experience eng Adel Zeinalpour Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. adel.zeinalpour@gmail.com Hamed Ebrahimibagha School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. H.ebrahimi@sbmu.ac.ir Koosha Sami School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. koosha.sami@sbmu.ac.ir Nahid Davari School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. nahid.davari@sbmu.ac.ir 2025 10 03 2025 12 27 OBJECTIVES: Acute abdomen is a common medical emergency characterized by sudden, severe abdominal pain lasting less than 24 hours, often necessitating urgent diagnostic and therapeutic evaluation. With the increasing availability of diagnostic tools, it is crucial to evaluate their sensitivity and accuracy to ensure their effective use. Plain abdominal X-rays and abdominal CT scans are among the most frequently used diagnostic tools for assessing acute abdomen. Methods: A total of 136 patients were enrolled in the study between April 2019 and March 2021. The sampling method was based on a comprehensive census of all patients presenting with acute non-traumatic abdominal conditions at Shahid Modarres Hospital. Initially, patients were clinically diagnosed, followed by a pre-operative diagnosis based on radiological findings, which were then compared with intra-operative results. Plain X-rays were performed for all patients, and CT scans were conducted for 75 of them. Fisher's exact test, t-test, and Chi-square test were used to study the associations between study groups. RESULTS:  CT scans, both with and without contrast, demonstrated superior accuracy compared to X-rays, particularly in detecting bowel obstructions, with a sensitivity of 100% and excellent correlation with postoperative findings. While X-rays remain highly accurate and sensitive for diagnosing perforations, they are less effective for identifying obstructions and vascular causes. CONCLUSION: Despite CT's high accuracy in diagnosing acute abdomen and its growing availability, abdominal X-rays remain the recommended first-line diagnostic tool due to their ability to detect many pathologies without further tests, as well as being cheaper and safer. However, in cases like obstructions or vascular pathologies, X-rays may be insufficient, making CT the preferred option. We advise physicians to use diagnostic studies purposefully, guided by clinical suspicion, and always after a thorough physical exam and patient interview.