Acute abdomen represents a complex clinical syndrome requiring rapid and accurate diagnosis to optimize patient outcomes. Computed tomography (CT) has evolved as a pivotal diagnostic tool in emergency medicine, offering detailed cross-sectional imaging for the evaluation of abdominal emergencies. This study aimed to evaluate the diagnostic accuracy, clinical utility, and impact of CT imaging in patients presenting with acute abdominal pain, and to assess its role in guiding therapeutic decision-making and improving patient outcomes. A prospective observational study was conducted on 642 patients presenting with acute abdominal pain to the emergency department between January 2021 and December 2023. All patients underwent contrast-enhanced CT examination within 6 hours of presentation. Diagnostic accuracy was assessed using surgical findings, clinical follow-up, and final discharge diagnoses as reference standards. CT demonstrated overall diagnostic accuracy of 94.2% for acute abdominal conditions. Sensitivity was highest for appendicitis (97.8%), bowel obstruction (95.6%), and perforation (93.4%). Specificity exceeded 95% for most conditions. CT findings directly influenced management decisions in 78.6% of cases, with 23.4% of patients avoiding unnecessary surgery. Emergency surgical intervention was required in 34.7% of patients, with CT correctly identifying surgical candidates in 96.1% of cases. CT imaging plays a crucial role in the evaluation of acute abdomen, providing high diagnostic accuracy, guiding therapeutic decisions, and significantly impacting patient management. Its integration into emergency protocols enhances clinical outcomes while optimizing resource utilization.