An analysis of the pattern of presentation, mode of management and outcome of patients with acute abdomen presenting at the general surgery unit of UITH, Ilorin was carried out. 276 patients were recruited for the analysis over a twelve month period. Only adult patients (>15yrs) were included in the study. Patients with medical and gynaecological emergencies were excluded.People between 16-45years constituted the bulk of patients (78.3%). The male to female ratio was 2.5:1. Most of the patients were students, civil servants and private businessmen. Appendicitis was commoner in students and civil servants, perforated typhoid was commoner among drivers and artisans and perforated peptic ulcer was commoner among policemen and security personnel. Abdominal pain was the commonest presenting symptom and abdominal tenderness was the commonest physical sign at presentation. Sixteen of the patients presented in shock and needed to be resuscitated out of which two died on the day of admission before surgery. About 41.3% of the patients had sought for medical attention elsewhere and were on some form of treatment before presentation. Other medical ailments (co-morbidities) were found in 11.2% of patients. The commonest co-morbidity was hypertension. Of the patients 51.8% presented within 3days of onset of symptoms. Initial diagnosis tallied with the final diagnosis in 82.3% of cases. Inflammatory lesions were the commonest presentations constituting 33.7% of cases closely followed by perforations (29.7%). This study reveals a high rate of perforated peptic ulcer 7.2% with gastric ulcer to duodenal ulcer ratio of 22:1 The mortality rate in this study was 13.0% occurring mainly in patients above 65 years, patients with overwhelming sepsis, faeculent peritonitis or penetrating abdominal gunshot injuries. Superficial surgical site infection was the commonest morbidity. No wound infection occurred in clean surgical wounds. There was associated wound dehiscence in 53.2% of patients with surgical site infection. Majority of the patients (75%) were discharged within two weeks of admission. Length of hospital stay correlated with type of morbidity in the patients. The patient with enterocutaneous fistula had the longest period of stay. Early presentation, appropriate resuscitation and prompt surgical intervention were noted to be associated with better outcome in patients with acute abdomen.