Abstract Background: Acute abdomen is one of the most encoun-tered presentations in daily surgical practice. Patients with acute pain abdomen present with a wide range of clinical signs and symptoms. Most of the time, signs and symptoms are subtle and are often overlapping. Missed or error in etiological diagnosis is common among acute abdomen pa-tients, carrying devastating consequences for the prognosis. The aetiology varies from region to region, influenced by various socio-demographic characteristics. Aim of Study: The aim of this study was to evaluate how diagnosis can be established using laparoscopy in case of acute abdomen and correlation between clinical findings as well as other investigations and laparoscopic findings and to evaluate therapeutic role of laparoscopy in acute abdomen and evaluating cases of acute abdomen. Patients and Methods: The present prospective study was conducted at General Surgery Departments, Ain Shams Uni-versity Hospitals and Al-Matria teaching hospital throughout September 2021 and August 2022. The study was carried out based on the ethical recommendations of the Ethics Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt. The surgical and clinical approaches were elucidated obviously for all patients, and the informed consents were assigned prior to study processing. The steps of the current study were implemented along with the guidelines of the Declaration of Helsinki. Results: DL accomplished higher diagnostic accuracy than US and CT and changed the diagnosis and subsequent clinical decision of 9.33% of patients compared to CT. Lapar-oscopy has become a routine procedure in the management of acute abdominal diseases, with a conversion rate to open surgery in laparoscopic cholecystectomy being about 5%. DL has an important role to play in undiagnosed acute abdomen patients both diagnostically as well as therapeutically. Conclusion: Diagnostic laparoscopy a feasible, effective, and safe diagnostic tool in patients with acute abdomen. It accomplished higher diagnostic accuracy in acute abdomen when compared with CT and US. Of note, DL changed the clinical decision in a considerable proportion of patients and improved their prognosis subsequently. Particularly, DL improved the management of acute abdomen patients, by making a definite diagnosis and access for immediate treatment. This reduced the perioperative complications, hospital stay, and readmission rates. It allowed early diagnosis and timely management of patients presented with acute abdomen in the emergency setting.