The results of 375 emergency abdominal operations in elderly patients over the age of 75 years are presented and discussed in detail. There has been a fourfold increase in the population over the age of 75 years in England and Wales during the 60-year period from 1911 to 1971. The overall mortality of these patients of 31-7 per cent is unrelated to the age of the patient, but appears to be directly related to the severity of the surgical condition and to cardiorespiratory complications. Our approach to these problems is presented and discussed.