Background: Emergency acute abdominal surgeries constitute a significant surgical burden with variable outcomes influenced by multiple factors. Objective: To analyze the patterns of presentation and management outcomes in emergency acute abdominal surgeries at a tertiary care center. Methods: A prospective observational study of 113 consecutive emergency abdominal surgery cases was conducted over 24 months. Demographics, clinical presentation, diagnostic findings, surgical interventions, and outcomes were analyzed. Results: The study population showed male predominance (80.5%) with majority in 20-40 years age group (59.3%). Appendicitis was the leading pathology (44.24%), followed by hollow viscus perforation (14.08%). Late presentation (>24 hours) occurred in 59.52% cases. The post-operative complication rate was 45.44%, with 17.6% requiring ICU care. Mortality rate was 8.8%. Conclusion: Delayed presentation significantly impacts surgical outcomes. Implementation of standardized protocols and improved public health awareness are recommended for better outcomes.