Aim: To analyze the clinical characteristics, etiologies, and outcomes of patients presenting with non-traumatic acute abdomen in a tertiary care hospital. Materials and Methods: This retrospective study was conducted in the Department of General Surgery, involving 200 patients aged 15 years and older who presented with non-traumatic acute abdominal pain. Pregnant women with pre-established diagnoses were excluded. Comprehensive clinical evaluations, including medical history, physical examinations, abdominal X-rays, and Ultrasonography (USG), were performed for all patients. Additional radiological and laboratory investigations were conducted as needed. Pain management was administered based on severity, and patients were followed up until discharge from the emergency department or admission to the ward, with final diagnoses recorded. Results: The study population included 65.5% males and 34.5% females, with the majority (58.5%) in the 16-31 age group. Acute appendicitis was the most common etiology (31.5%), followed by intestinal obstruction (12.5%) and nephrolithiasis (10.5%). Complications were observed in 17.5% of patients, and the overall mortality rate was 2%. Timely interventions and appropriate management contributed to favorable outcomes, as evidenced by a 98% survival rate. Conclusion: This study demonstrates the variability in the clinical presentation and etiologies of non-traumatic acute abdomen. Younger age groups and males were predominantly affected, with acute appendicitis being the leading cause. Effective diagnostic strategies and timely management minimized complications and mortality, underscoring the importance of systematic approaches in acute abdominal emergencies.