Aim: To assess intra-abdominal pressure (IAP) changes and their association with morbidity, mortality, and complications in patients undergoing emergency laparotomy. Material and Methods: This observational study was conducted on 60 patients in the Department of General Surgery at Sri Aurobindo Medical College and Postgraduate Institute, Indore. Inclusion criteria were patients above 18 years of age undergoing emergency laparotomy, while those who did not complete treatment or provide consent were excluded. Pre-operative and post-operative IAP measurements were recorded at specific intervals using a sterile saline manometer connected to a tri-way urinary catheter. Data on demographic characteristics, complications, morbidity, and mortality were collected and analyzed using appropriate statistical methods. Results: The mean pre-operative IAP was 15.2 ± 3.1 mmHg. A significant decrease in IAP was observed post-operatively, with values reducing to 7.5 ± 1.8 mmHg by day 10 (p < 0.001). Morbidity and mortality rates were 36.67% and 13.33%, respectively, with a mean hospital stay of 10.5 ± 3.4 days. The most common complications were wound infections (20.00%) and respiratory distress (13.33%). Elevated pre-operative and day 1 post-operative IAP levels were significantly associated with mortality (p = 0.013 and p = 0.009, respectively). Conclusion: This study demonstrates that timely monitoring and management of IAP can significantly improve outcomes in emergency laparotomy patients. Elevated IAP levels were strongly associated with higher morbidity, mortality, and complications, highlighting the importance of early interventions and vigilant post-operative care.