Objective To explore the value of MRI in the diagnosis of acute abdominal disease. Methods The MRI findings of 40 patients with intestinal acute abdomen were analyzed retrospectively and all cases were confirmed by surgery, pathology or clinical diagnosis. Results There were 19 cases of malignant lesions in total, and 17 cases with intestinal obstruction, including primary colorectal cancer with obstruction in 9 cases, peritoneal metastases with obstruction in 5 cases, intestinal lymphoma with obstruction in 2 cases, intestinal stromal tumor with obstruction in 1 case; besides, rectal cancer with perforation, infection and sigmoid colon cancer with peripheral infection in 1 case. There were 21 cases of benign lesion in total, 12 cases with intestinal obstruction: 7 cases of simple adhesive intestinal obstruction, 5 cases of obstruction caused by other causes; the other 3 cases of intestinal perforation with peripheral infection, 2 cases of mesenteric angiopathy ; besides, ileocecal tuberculosis, ileoceae infection with abscess, abdominal hernia and mesenteric adhesion torsion in 1 case. This group of patients with MRI on the diagnosis of intestinal acute abdomen. The localization accuracy rate was 92.5％(37/40), the qualitative diagnostic sensitivity was 90.91% and specificity was 94.44%, and the diagnostic accuracy rate was 82.5% in this group of patients. Conclusion MRI has high accuracy for the discovery and display of the lesions, as well as the diagnosis of localization, qualitative and etiological diagnosis. It can provide important information for the selection of clinical treatment programs. It is of great value in the diagnosis of acute abdomen.