Four cases of acute abdomen in para- and tetraplegic patients are reported. One patient had a perforated duodenal ulcer without clinical symptoms, while another had abdominal contracture of neurological origin. Two cases of occlusive syndrome associated with faecaloma and with volvulus of the small bowel are also described. The absence or alteration of classical symptoms makes the diagnosis of abdominal emergencies particularly difficult in paraplegic patients. A better knowledge of the clinical pictures encountered in such cases, close supervision of the patients and carefully selected complementary examinations should help to avoid these problems and result in an early surgical decision.