Acute abdomen accounts for approximately 5–10% of all emergency room visits with about a 60% rate of secondary hospital admission. The etiology of admission for acute abdomen remains indeterminate up to 40% even in experienced hands, therefore the imaging approach remains crucial. In the context of an acute abdomen, MDCT has become the gold standard because it supports the diagnosis and suggests the most timely and tailored management approach. The use of intravenous contrast is essential because it improves CT diagnostic accuracy, enhancing vascular structures and organ differentiation. However, given the large extent of the clinical manifestations of abdominal pain, the choice of the right CT protocol for the right patient is often challenging. In this chapter, each CT protocol will be discussed according to the clinical queries and patient symptoms.