Aim: The aim of this retrospecti ve study was to determine the diagnosti c value of computerized tomography (CT) in pati ents without prior surgery who presented with clinical signs and symptoms of acute abdomen with the goal of assessment of the need for surgery and the detecti on of causes of acute abdomen. Pati ents and methods: This retrospecti ve study included all adult pati ents without prior surgery who were referred to perform abdominal CT scan with the diagnosis of acute abdomen in the period from October 31st 2014 ti ll October 31st 2015. Pati ents who had laparotomy of laparoscopy performed within 30 days prior to CT examinati on and those who died during hospitalizati on aft er the CT examinati on and without surgery were excluded. Reference standards in this study were surgery report and hospital observati on during 30 days aft er CT exam in pati ents who had no surgery. CT exams were independently analysed by two radiology specialists with more than 5 years of experience in abdominal CT imaging and all disagreements were sett led with consensus. Results: Out of 81 pati ents (age 19-91, median 69 years, male/female rati o 45/36) 51 had emergency surgery. Duodenal/gastric ulcer perforati on, diverti culiti s and appendiciti s with complicati ons, bowel perforati on and complicati ons of acute cholecysti ti s were the most common causes for surgery. Sensiti vity and specifi city of abdominal CT were 94.6% and 84.6%, while positi ve and negati ve predicti ve values were 93.0% and 87.5%, respecti vely. In pati ents with true positi ve results, CT successfully assessed the localizati on of the cause of acute abdomen in 83% of pati ents. Conclusion: Abdominal CT examinati on in pati ents with signs and symptoms of acute abdomen is a reliable diagnosti c method in the assessment of indicati on for surgery and the detecti on of causes of acute abdomen.