This study evaluates the diagnostic accuracy of clinical assessment and imaging modalities (X-ray, ultrasound, and CT scan) in diagnosing acute abdominal conditions, including perforation, appendicitis, and small bowel obstruction (SAIO), compared to intraoperative findings. A diverse cohort was analyzed based on socio-demographic factors, clinical complaints, and diagnostic results. Clinical assessment showed moderate sensitivity and specificity across all conditions, with the highest performance in SAIO (sensitivity: 72.7%, specificity: 94.8%). X-ray was highly effective for diagnosing SAIO (95.5% accuracy) but less accurate for perforation (76.1%). Ultrasound demonstrated high accuracy for appendicitis (87.5%) and SAIO (95.5%), but its sensitivity for perforation was low (43.5%). CT scans outperformed all other modalities, achieving 92% accuracy for appendicitis, 96.6% for SAIO, and 95.5% for perforation. The findings suggest that a multi-modal diagnostic approach, combining clinical assessment and imaging, is crucial for accurate diagnosis and optimal management of acute abdominal conditions.