Introduction: Acute abdomen is the presentation of sudden severe abdominal pain with multiple causes which can be non-operative of even life-threatening.The main objective of the study is to find the diagnostic accuracy of ultrasonography in acute abdomen taking operative findings as gold standard.Methods: This cross-sectional study was conducted atwas conducted atMaheshwara Medical College & Hospital. The study included a total of 210 patients who presented to the emergency department with acute abdominal pain and were subsequently admitted for further evaluation and management. All patients underwent a thorough clinical examination followed by ultrasonography performed by a radiologist experienced in abdominal imaging. The ultrasonographic evaluation aimed to identify the cause of acute abdomen, such as appendicitis, cholecystitis, bowel obstruction, or any other intra-abdominal pathology. Results: A total of 210 patients presenting with acute abdominal pain were included in the study. The age range of the patients was 18 to 75 years, with a mean age of 42.5 years. Of the 210 patients, 120 were male (57.1%) and 90 were female (42.9%).The majority of patients were aged between 46 and 60 years (33.3%), followed by those aged 31 to 45 years (28.6%). For acute appendicitis, it achieved a sensitivity of 89.5%, specificity of 95.7%, and accuracy of 92.9%, with a statistically significant P-value of <0.001. In diagnosing cholecystitis, the sensitivity was 87.3%, specificity 98.7%, and accuracy 95.2%, also with a P-value of <0.001. Bowel obstruction had a sensitivity of 89.3%, specificity 97.2%, and accuracy 92.9%, with a P-value of <0.001.Conclusion: Ultrasonography is a valuable diagnostic tool for assessing acute abdomen, demonstrating high sensitivity, specificity, and accuracy in diagnosing conditions like acute appendicitis, cholecystitis, and bowel obstruction.