Imaging in Acute Abdominal Emergencies: A Narrative Review of Surgical Decision-Making and Outcomes

Acute abdominal pain remains a common cause of emergency presentations, and modern imaging has transformed its evaluation and management. The introduction of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) is generally believed to have improved diagnostic accuracy, reducing unnecessary surgical exploration and enabling safer, more targeted interventions. This review summarizes current evidence on the role of imaging in conditions such as appendicitis, trauma, diverticulitis, and bowel obstruction, highlighting its impact on surgical outcomes and clinical pathways. Key issues include balancing diagnostic speed with concerns over radiation exposure, cost, and potential overuse, particularly in vulnerable populations. Emerging technologies such as low-dose CT, artificial intelligence, and point-of-care imaging are likely to further refine practice, while addressing global disparities in access remains an ongoing challenge. This review uniquely synthesizes recent guideline updates and outcome-based evidence to highlight how modern imaging has redefined surgical decision-making in acute abdominal emergencies.