Abdominal pain is one of the common complaints encountered in the emergency. On an average, 6.8% of the patients present to the ER with complain of pain abdomen. Considering the busy ED environment, limited resources and the need for attending to an impending doom of clinical scenarios ranging from mild itch to life threatening injuries, it might not be easy for any emergency physician to look for what an abdomen is hiding as it has aptly been called as the Pandora’s box. The authors conducted a retrospective observational study in the emergency department where in patients presenting with abdominal pain where prospectively followed through the course of ED and hospital stay. On the basis of patients parameters like presenting complaints, severity and duration of symptoms, physicians attending time, diagnostic working modalities and final outcome in terms of symptom relief, underlying pathology, need for surgical or other interventional procedures. The management of pain abdomen in the emergency department is now taking a lead in coherence of provisional diagnosis and final diagnosis with trained personnel in emergency.