ABSTRACT Background: Abdominal pain is common in children that can manifest as acute or chronic. In some cases, are requires immediate management. The most difficult challenge is to make diagnosis to identify the cause. Objective: This study is aimed to demonstrate the evidence of the use of abdominal ultrasonography (AUS) to determine the cause of pain in relation to surgical decision. Methods: Patients with acute abdominal pain were referred for AUS. Prospective cross- sectional method was done in 268 children aged 5 to 15 years old, in which 116 of them are male. Patients who did not require surgery and outpatients were asked to make a response whether the improvement during and after the treatment. Patient who were required surgical, will be confirmed by histopathology. Results: No abnormalities (53.73%). The abnormal findings were: enterocolitis (13.43%), mesenteric adenitis (12.68%), constipation (6.72%), appendicitis (6.34%), cystitis (5.97%), adrenal tumor (0.07%) and intussusception (0.04%). Findings shows, the use of AUS to deter mine the cause were able to reduce surgical decision from 27.98% to 7.46%. Thus, ultrasonography changed the management plan in 20.52%of patients. Conclusion: The AUS is useful for evaluation abdominal pain in children. An accurate diagnosis is important to prevent unnecessary surgery. Keywords: Abdominal Ultrasound, Acute Abdominal Pain, Children. Correspondence: Herlina Uinarni Department of Anatomy, School of Medicine and Health Sciences, Atma Jaya Chatolic University of Indonesia Department of Radiology, Pantai Indah Kapuk Hospital, Jakarta, Indonesia E-mail: herlina.uinarni@atmajaya.ac.id DOI: 10.31838/srp.2020.4.56 @Advanced Scientific Research. All rights reserved