Attacks of acute abdominal pain with fever, muscle spasm and leukocytosis occur not infrequently with sickle cell anemia. The attacks are often severe and may be associated with signs and symptoms strongly suggesting various acute abdominal diseases. In fact, the picture may so closely simulate such a condition as to be almost indistinguishable, even if the patient is known to have sickle cell anemia. Furthermore, persons with sickle cell anemia are just as subject to the other abdominal diseases as any one else, and instances of cholelithiasis, appendicitis and other emergency conditions are well known. Hence, it is important for a surgeon to be familiar with the painful manifestations of sickle cell anemia. It is to enumerate the symptoms and signs most commonly found in this interesting phase of the disease and to report six cases in which the abdominal manifestations were outstanding that this paper is written.