Patients with nonspecific abdominal pain can have any one of many disease processes. The physical examination may not reveal clear abnormalities, making the diagnosis more difficult. Vascular abdominal emergencies are not common but, when present, may be catastrophic, with significant morbidity and, frequently, mortality. Most of the conditions are time sensitive, leaving the integrity of organ blood flow at risk. Thromboembolic disease leads to ischemia and eventual infarction of the intra-abdominal organs. Aneurismal dilation of the aorta with rupture leads to rapid hypovolemic shock and death if not diagnosed. A high index of suspicion is critical to the successful diagnosis.