Abstract Aim Drives towards ambulatory management in emergency surgery have resulted in increased availability of urgent imaging to expedite decision making. This review of CT usage aimed to assess frequency of surgical pathology identified, and subsequent management. Methods All acute general surgery referrals to an established ambulatory clinic between 01/01/2021 and 22/07/2022 were included. Information regarding presentation, imaging, and diagnosis were collected in prospectively maintained databases, and subsequently analysed. Results 3154 patients were seen over an 18-month period with a 91.7% successful ambulation rate (n=2938). CT was performed in 577 patients (18.2%); the majority were contrast CT abdomen/pelvis (CTAP, 58.3%, n=331), or CT Kidney/Ureter/Bladder (CTKUB, 40.1%, n=228). The majority of CTAPs were diagnostic (77.0%, 242/331), with 16.0% (n=53) resulting in admission; admission rate for non-diagnostic CTAPs was 4.5% (n=4/89). Subsequent operations occurred in 9.6% (32/331) who underwent CTAP; 5.1% (17/331) underwent emergency operation, urgent ambulatory operations in 3.0% (10/331), and 1.5% (5/331) were listed electively. CTKUBs identified urological pathology in 40.4% (n=92), whilst 7.4% (n=17) identified other pathology. Diagnostic CTKUB led to a 17.5% admission rate (n=17, including 5 non-urological). Conclusion Selective ambulatory CT scanning is a useful adjunct to diagnosis, and admission avoidance. CTKUBs identify lower, but acceptable levels of pathology including non-urological conditions. Judicious use of CT is important to balance resource utilisation, whilst limiting admissions.