With the population ageing, each physician will increasingly be confronted with older patients, who often suffer from multiple ailments. In such population, abdominal pain, though a frequent complaint, can present a real challenge as history and clinical examination may be misleading. This symptom is however the fourth most frequent ground for consultation in the emergency department and is often a major consumer of time and money. It therefore seems essential to address each case of abdominal pain in the elderly with methodology and bearing in mind at all times that the usual clinical signs may be missing or deceiving. Diagnosis of nonspecific abdominal pain often marks the end of the consultation once the worst has been excluded.