Introduction: Surgical acute abdomen is an important cause of morbidity and mortality. Its pattern is known to vary from one place to another and also to change over time. The aim of this study therefore was to ascertain the present pattern of surgical acute abdomen in Port Harcourt. Patients and Methods: All patients with surgical acute abdomen admitted into the University of Port Harcourt Teaching Hospital, Port Harcourt between January and November, 2004 were evaluated. History, physical examination and relevant investigations were conducted. Patients requiring surgery were properly prepared and surgery performed. Those not requiring surgery were appropriately investigated and treated. Relevant specimens were collected intra-operatively and findings at surgery recorded. Data obtained were demographic, clinical and pathological including results of the investigations. Standard medical principles and a proforma (APPENDIX I) were used. Data obtained were subjected to statistical analysis using the SPSS Package. Results: One hundred and eighty (180) patients were evaluated in this study. Their ages ranged between 5 days and 72 years. The mean age was 25±15.9 years. There was a slight male preponderance. The commonest cause of surgical acute abdomen was acute appendicitis 85 (47.2%). This was followed by abdominal trauma 46 (25.6%) and intestinal obstruction 35 (19.4%). Other causes were 14 (7.8%). Most patients presented in hospital after the first day of onset of symptoms. Only 73 (40.6%) patients presented in hospital within 24 hours of illness. A total of 34 (18.9%) developed post-operative complications. The most common complications were wound infection 11 (32.4%) and septicaemia 11 (32.4%). Complications were significantly higher in patients whose duration of symptoms was more than 24 hours than those who presented within 24 hours of symptoms. Complications were also significantly higher in the extremes of life. The mortality rate was 10%. Deaths were significantly more in the extremes of life. Mortality was not affected by the duration of symptoms. Conclusion: The commonest causes of acute abdomen were acute appendicitis, abdominal trauma and intestinal obstruction in decreasing order. Previously, intestinal obstruction was the second leading cause. It is difficult to conclude after an 11-month study that the pattern of surgical acute abdomen has indeed changed. It however raises the possibility of a changing pattern. Further work would be required in this regard.