The results of exploratory laparotomy in 48 patients with an acute abdomen are reviewed. Overall mortality was 29 p. cent (14 cases) and was influenced by three main factors: patients over 50 years of age, multiple visceral lesions, and when exploratory laparotomy was conducted for an acute painful febrile abdominal syndrome (10 deaths in 32 cases) or during the postoperative period (4 deaths in 11 cases). In contrast, exploratory laparotomy is a benign procedure in patients with abdominal contusions. It is essential, therefore, to try to establish the diagnosis before proposing laparotomy, which should only be performed when all other diagnostic investigations have proved negative.