BACKGROUND: The COVID-19 pandemic is standing as a never before threat to the healthcare systems and hospital operations worldwide.Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of surgery. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services. OBJECTIVES: This study was aimed to evaluate the changes in approach to management and the perioperative outcome of patients with acute surgical emergency during COVID-19 pandemic. STUDY DESIGN AND METHODS:We performed a retrospective observational study in patients presented with acute surgical emergency between April 2020 to June 2021. RESULTS: A total of 298 patients were included, among whom 12 (3.4%) were COVID 19 positive. 274 non-COVID patients and 8 COVID-19 positive patients underwent emergency surgery.While 12 non-COVID (4.1%) and 4 COVID-19 positive patients (40%) underwent conservative management. None of the hospital staff involved in the surgeries of COVID-19 positive patients developed any symptoms related to COVID-19. CONCLUSION: This study showed that the patients with surgical emergency both with or without COVID-19 infection were successfully treated,without influencing each other,through appropriate isolation measures,although managed in the same hospital. Importance can also be given towards conservative management particularly for COVID-19 positive patients presenting with surgical emergency selectively with proper monitoring. So it can be concluded that, although the management of surgical patients during the COVID-19 pandemic is a global challenge,adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.