Introduction: The perioperative management of an elderly patient is significantly particular due to age-related physiological and pharmacological changes. Emergency surgery in the elderly patient corresponds to a major and disturbing life event for the patient. Objective: To evaluate the perioperative management of abdominal surgical emergencies in elderly patients. Methodology: This is a retrospective, descriptive and analytical study conducted over 3 years from January 1st, 2022 to December 31th, 2024. We included in the study all patients aged 60 years and older who were operated on for a non-traumatic abdominal surgical emergency. Results: We collected and included 74 medical recording, representing a frequency of 2.5%. The sex ratio was 1.04. The average age was 71.5 years with extremes of 60 to 91 years. Patients were classified as ASA 2u in 59.4% and ASA 1u in 32.4%. Charlson’s index was on average 3.1 with extremes from 2 to 6. Surgeries were rated Altemeier 4 in 39.2%. The preoperative indications were dominated by acute bowel occlusions in 43.2%, strangulated abdominal wall hernias in 25.6%, acute peritonitis in 12.1% and acute appendicitis in 12.1%. Preoperative acute kidney injury was found in 27%. In the postoperative phase, 36.4% of patients were admitted to intensive care unit. The reasons for admission to intensive care unit were delayed awakening (64%), hypovolemic shock (9.5%) and respiratory distress (5.4%). The state of hypovolemic shock (12.1%), postoperative acute kidney injury (5.4%) and acute respiratory distress syndrome (5.4%) were the main postoperative complications. The evolution was favorable in 78.4% and the mortality was 21.6%. The causes of death were septic shock in 68.7% and cardiogenic shock in 31.3%. Factors associated with mortality were age, ASAu score, Charlson index, preoperative acute kidney injury (AKI), perioperative anuria, pulmonary inhalation, admission to intensive care unit, septic shock, postoperative AKI,