The acute abdomen represents an emergency condition which requires urgent diagnosis and therapy. Sonography plays an important role as a fast, effective and efficient imaging modality. Most causes of the acute abdomen can be diagnosed with ultrasound, however, ultrasound has its domain in the diagnosis of biliary tract disorders and in evaluating abdominal tumors. Beside B-mode sonography, contrast-enhanced ultrasound is increasingly used to diagnose organ infarction. Sensitivity as well as specificity in the diagnosis of acute appendicitis are high, and sonography may play an important role in describing sigma diverticulitis. Although the pancreas is often invisible due to gas, newer studies describe the use of contrast-enhanced sonography in this context. Intraabdominal fluid can be punctured sonographically, and cysts, abscesses and exsudates may be cured with drainages. Sonographically guided biopsy helps in the diagnosis of suspect solid lesion in the abdomen. Sonography may diagnose the most common causes of acute abdomen. However, the multifactorial etiology of this condition represents a challenge,and interdisciplinary cooperation is essential.

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