Is there still a role for abdominal plain X-ray in acute abdomen?

The imaging workup of patients with acute abdominal pain still starts with abdominal X-ray in several clinical settings and facilities. Unfortunately, conventional plain film is of limited utility if performed as a routine investigation. Abdominal radiography is valuable only in patients with suspected perforated viscus and large bowel obstruction. Ultrasound is mostly valuable in the vast majority of abdominal pain presentations, whereas computed tomography scan should be considered as second level test.