Aim: The aim of the present study to determine the incidence of abdominal malignancies presenting as acute abdomen in an emergency department. Methods: This was a prospective observational study conducted in the Department of General Surgery, Anugrah Narayan Magadh Medical College & Hospital , Gaya Bihar, India for 1 year. 80 patients with acute abdominal emergencies were included in the study. Patients or their caretakers were interviewed in the casualty wing, after obtaining proper informed consent. Details were collected regarding the onset, type, duration and other details pertaining to the pain, details regarding abdominal distension, bleeding per rectum (PR),provisional diagnosis of treating surgeon, as well as follow up histopathology report (HPR) and final diagnosis. Results: out of 440, 280 were males and 160 were females. Of these 80 (18.18%) patients had malignancy. Out of the 280 males, 17.5% were diagnosed to have malignancy, compared to 19.37% in females. 73.75% of the patients detected with malignancy were above 50 years. Carcinoma colon was the most common malignancy (53.75%) in this study, with carcinoma stomach and Carcinoma rectum being the second most common. The most common presentation of malignancy was obstruction (73.75%) followed by perforation (22.5%). Patients who ended up having malignancy, were found to be suffering from low grade pain for longer durations than non-malignant cases. Most of them had previous episodes of abdominal pain, colicky being the most common type of pain pattern. Abdominal distension, bleeding PR and constipation were found to be more associated with malignancy, probably because colon malignancies were the predominant ones. Conclusion: In the era were the incidence and early detection of abdominal malignancies are on a rise, a significant portion of these cases present with acute abdominal symptoms and the morbidity associated with such a presentationis of importance. Early detection of the disease by screening is the solution for this.