We reviewed 201 consecutive patients aged over 65 years who were operated on for acute abdomen during the period 1986-89. Emergency procedures were most commonly performed on the biliary tract (24%), the appendix (20%), bowel (15%) and abdominal wall (12%). The postoperative morbidity was 26%, and the mortality rate of 22% was related most commonly to mesenterial thrombosis and intestinal obstruction. In fatal cases, 44% of the patients were over 80 years old and 64% were placed into the ASA classes IV-V. Eighty-four patients (42%) underwent postoperative intensive care, and 22 re-operations (9.0%) were performed. The mean hospital stay was 12 days and 70% of patients returned home after surgery. In conclusion, the outcome of emergency abdominal surgery in patients under 80 years of age and with no serious co-existing diseases has improved. Very old patients in ASA classes 4-5 still have a poor outcome.