Background <p>The global population is aging rapidly, leading to a significant increase in geriatric patients requiring emergency surgical intervention. This demographic presents unique challenges due to high frailty, multisystem comorbidities, and atypical disease presentations, which contribute to elevated surgical risks and poorer outcomes compared to younger populations.</p> Objective <p>This review aims to synthesize the current research landscape regarding emergency general surgical conditions in older adults. It focuses on the common disease spectrum, evolving management strategies, and critical prognostic determinants to inform and enhance evidence-based clinical practice.</p> Methods <p>A comprehensive literature review was conducted to delineate the etiology of acute abdomen in the elderly, evaluate the utility of preoperative assessment tools and surgical approaches, and identify key factors influencing patient outcomes, including mortality and complication rates.</p> Results <p>Acute appendicitis, intestinal obstruction, gastrointestinal perforation, and biliary diseases represent the most prevalent conditions. Precise preoperative risk stratification using scoring systems like POSSUM is crucial. For hemodynamically stable patients, a laparoscopic-first approach is associated with reduced complications and shorter hospital stays. Prognosis is critically influenced not just by age, but more significantly by frailty, multimorbidity, and psychosocial factors. The integration of Multidisciplinary Team (MDT) models and rehabilitation medicine principles is pivotal for optimizing comprehensive care.</p> Conclusions <p>The management of geriatric emergency surgical patients necessitates a tailored, multidimensional strategy. Future efforts to improve outcomes should focus on refined preoperative optimization, the promotion of minimally invasive techniques, and the systematic implementation of multidisciplinary collaboration and early rehabilitation.</p>