Background: Acute abdomen is a surgical emergency, that needs early diagnosis and treatment to avoid complications and save patient life. However, accurate diagnosis is crucial to avoid unnecessary surgery. Laparoscopy could represent an optimal solution in these circumstances. The aim of the work:To evaluate the role of laparoscopy in management of doubt cases of acute abdomen. Patients and Methods:It is a prospective study, which held at Al-Azhar University Hospital [Damietta] during the first six months of 2020 and included 30 patients who presented by acute abdominal pain. All were evaluated by full history taking, clinical examination, laboratory and radiological investigations. Then, all underwent diagnostic laparoscopy, which had been continued to therapeutic laparoscopy, or converted to laparoscopy-assisted laparotomy at the same setting. Rate of success, operative diagnosis and postoperative complications were documented. Results:The most common cause of acute abdomen was acute appendicitis [23.33%] followed by acute cholecystitis [13.33%], then perforated peptic ulcer [10.0%]. Negative exploration had been reported in 10%. Therapeutic laparoscopy was successful in [56.7%] while [43.3%] required conversion to laparotomy. Complications were observed in 14 patients [46.7%] and wound infection is the most common [30.0%]. Radiological investigations failed to elaborate diagnosis in 12 patients, and laparoscopy achieved the diagnosis in 9 [75.0%] of them. Conclusion:The laparoscopic approach in doubt acute abdomen is proved to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. It reduces pain, improves recovery, shortens hospitalization and improves cosmetic results.